NEW YORK STATE DEPARTMENT of HEALTH
OFFICE of HEALTH SYSTEMS MANAGEMENT
DIVISION of CERTIFICATION & SURVEILLANCE
A Request for Proposals
State Surveillance Activities for
Hospitals and Diagnostic & Treatment Centers
RFP Number: 1005101128
___________________________________________________________________
Schedule of Key Events
RFP Release Date:..................................................................... August 16, 2010
Written Questions Due: ............................................................ August 27, 2010
Letter of Intent Due (optional): ................................................. August 30, 2010
Response to Written Questions:........................................ September 13, 2010
Proposal Due Date: .................................................................... October 4, 2010
Contacts Pursuant to State Finance Law Sections 139-j and 139-k
Designated Contact:
Pursuant to State Finance Law Sections 139-j and 139-k, the Department of Health
identifies the following designated contacts to whom all communications attempting to
influence this procurement must be made:
Jonathan P. Mahar
Grants & Procurement Unit, Rm. 1341
New York State Department of Health
Phone – 518/ 474-7896
Fax – 518/ 474-8375
[email protected]
Permissible Subject Matter Contact:
Pursuant to State Finance Law Section 139-j(3)(a), the Department of Health also
identifies the following allowable contact for communications related to the following
subjects:
RFP Release Date
Submission of Written Proposals or Bids
Submission of Written Questions
Debriefings
Negotiation of Contract Terms after Award
Barbara DelCogliano
Division of Certification & Surveillance
New York State Department of Health
433 River Street – 6th Floor
Troy, New York 12180
Phone – 518/ 402-1003
Fax – 518/ 402-1010
[email protected]
For further information regarding these statutory provisions, see the Lobbying Statute summary in Section
10 of this solicitation.
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TABLE of CONTENTS
RFP SUMMARY ........................................................................................................................... 1
SECTION 1:
INTRODUCTION and BACKROUND ................................................................ 2
SECTION 2:
DETAILED SPECIFICATIONS .......................................................................... 4
SECTION 3:
WORKLOAD PROJECTIONS and
DEFINITION of COMPLETED SURVEILLANCE UNITS ................................. 8
SECTION 4:
STAFFING REQUIREMENTS and TRAINING................................................ 11
SECTION 5:
NYSDOH RESPONSIBILITIES........................................................................ 11
SECTION 6:
CONTRACTOR RESPONSIBILITIES.............................................................. 12
SECTION 7:
PROPOSAL REQUIREMENTS ....................................................................... 13
SECTION 8:
METHOD of AWARD....................................................................................... 16
SECTION 9:
SUBMISSION and PROPOSAL FORMATTING REQUIREMENTS ............... 17
SECTION 10:
ADMINISTRATIVE ........................................................................................... 23
SECTION 11:
CONTRACT APPENDICES ............................................................................. 30
SECTION 12:
ATTACHMENTS .............................................................................................. 31
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RFP SUMMARY
The RFP is a request by the Department of Health for proposals from qualified
organizations* to conduct, under the Department’s oversight and direction, some
ongoing State surveillance activities for hospitals and diagnostic & treatment centers in
New York State. The contract is expected to be for a five year period.
In accordance with the provisions of the RFP, the following activities are included:
• Receipt, review, and referral of consumer complaints and facility-reported incidents
related to Article 28 hospitals and diagnostic & treatment centers; approximately
4,100 complaints/incidents per year in Central Office.
•
Onsite routine surveys at Article 28 diagnostic & treatment centers; approximately 45
surveys per year predominantly in the New York City metropolitan region.
•
Onsite consumer complaint and facility-reported incident investigations of Article 28
hospitals and diagnostic & treatment centers; approximately 165 surveys per year
statewide.
•
Offsite consumer complaint and facility-reported incident investigations of Article 28
hospitals and diagnostic & treatment centers; approximately 450 surveys per year
statewide.
•
Review Root Cause Analysis reports generated from specific facility-reported
incidents at Article 28 hospitals and diagnostic & treatment centers; approximately
600 reviews per year statewide.
In order to qualify for this RFP, an organization must be composed of or commit to the
availability of sufficient staff to carry out a statewide surveillance program as outlined.
To support a statewide program the contractor must maintain staff and resources
sufficient to conduct statewide surveillance surveys/investigations, evaluate/review
findings, operate a centralized intake program, and maintain tracking systems and data
resources to support a statewide operation. One and only one contractor will be
selected for this contract. Any proposal that fails to provide for a statewide surveillance
program may be found to be non-responsive.
Any potential contractor must confirm to the Department that it is a qualified
organization and that the contractor has no real or perceived conflict of interest with
respect to conducting the duties and responsibilities in this RFP. The Department
reserves the right to disqualify any organization that is not able to sufficiently
demonstrate that it is free of any conflict of interest.
* Qualified Organization: The Department will accept proposals only from public or
private organizations, companies, partnerships, or corporations that are authorized to
operate in New York State. Such organization and its subsidiaries may not be a
provider of health care services, a health care facility accrediting body or any
organization or trade association whose primary business includes representing any
Article 28 licensed provider.
1
SECTION 1: INTRODUCTION and BACKROUND
In conjunction with the Department’s oversight responsibilities, the New York State
Department of Health (the Department or NYSDOH) is requesting proposals from
qualified entities to assist the Division of Certification & Surveillance with carrying out
ongoing State surveillance activities of hospitals and diagnostic & treatment centers
(DTCs).
State laws and state regulations impose a variety of standards on how the State
assures quality care and outcomes for patients of hospitals and DTCs. The contractor
will assist the Department in assessing facilities’ compliance with such standards.
Types of Facilities
A hospital is a facility engaged in providing medical or medical and surgical services
primarily to in-patients by or under the supervision of a physician on a twenty-four hour
basis with provisions for admission or treatment of persons in need of emergency care
and with an organized medical staff and nursing service, including facilities providing
services relating to particular diseases, injuries, conditions or deformities. There are
currently 235 acute care and critical access hospitals in New York licensed by
NYSDOH. The governing statutory and regulatory authority for hospitals is Public
Health Law Article 28 and 10 NYCRR Part 405.
A diagnostic and treatment center (DTC) is a medical facility with one or more organized
health services, not part of an inpatient hospital facility or vocational rehabilitation
center, primarily engaged in providing services to out-of-hospital or ambulatory patients
by or under the supervision of a physician for the prevention, diagnosis and treatment of
human disease, pain, injury, deformity or physical condition. DTC providers may
include primary medical care clinics as well as Ambulatory Surgery Centers (ASC), End
Stage Renal Disease (ESRD) dialysis facilities, Comprehensive Outpatient
Rehabilitation Facilities (CORFs), Rural Health Clinics (RHCs) and Outpatient Physical
Therapy Facilities (OPT). There are currently about 520 DTC operators with
approximately 1,230 sites. The governing regulatory authority for DTCs is NYCRR
Parts 750 and 751.
Types of Surveillance
The Department conducts surveillance activities in several categories including periodic
surveys, complaint-initiated investigations, and facility-reported incident investigations.
The Department conducts routine, periodic surveys at DTCs and hospitals. These onsite surveys are unannounced but typically occur on a cyclical basis and are spread out
over the year-long period. The purpose of the unannounced surveys is to ensure ongoing compliance with state regulations and standards. The surveys look at the
operation of the facility in whole including patient care and physical environment. The
contractor will assist the Department with periodic surveys conducted at DTCs.
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The Department is also responsible for complaint-initiated investigations at DTCs and
hospitals. Complaint allegations are received by the Department in a variety of ways
including directly via the Departments centralized hospital and DTC complaint intake
unit, via the Centers for Medicare and Medicaid Services (CMS), and via media reports.
All complaints, regardless of the source, pass through the centralized complaint unit.
The unit is charged with receiving, reviewing and triaging the complaints. All complaints
accepted for investigation are categorized by severity and needed actions. Some
complaints are resolved by the centralized complaint unit directly. The majority of
complaints are referred to surveyors for either off-site or on-site investigations. These
investigations are focused in nature and can include, but are not limited to, on-site
observation, interviews, review of medical records, facility policy and procedure reviews
and review of facility internal investigations,
Additionally, the Department is charged with the review, triage, and quality assessment
of facility-reported incidents received through the New York Patient Occurrence
Reporting and Tracking System (NYPORTS). Both hospitals and DTCs are statutorily
mandated to report specific categories of adverse events. Based on the review and
triage of a NYPORTS incident, the Department may close the incident, review facilityprepared Root Cause Analysis (RCA) reports, or conduct an investigation for
compliance with applicable state standards. Investigations are similar to complaintinitiated investigations, encompassing comparable actions, and may occur on-site or
off-site.
Program Overview
NYSDOH operates its hospital and DTC surveillance program with a regionalized
approach. The state is divided into four regions with some of the regions subdivided for
a total of seven offices. Each region is responsible for conducting the surveillance
activities related to the health care facilities located within that region. Coordination,
oversight, and tracking are performed in what is referred to as Central Office, located in
Troy, New York, as is the centralized complaint unit.
The four regions are:
1. Metropolitan Area Regional Office (MARO) with three office locations
MARO: New York City
MARO: Long Island (West Islip)
MARO: New Rochelle
2. Capital District Regional Office (CDRO) with one office located in Troy
3. Central New York Regional Office (CNYRO) with one office located in Syracuse
4. Western Regional Office with two office locations
WRO: Rochester
WRO: Buffalo
And as stated above, Central Office is located in Troy. See Appendix # for a map
depicting the regions and their affiliated offices.
Surveillance activities, in each region, are overseen by the Hospital Program Directors
(HPDs). The HPDs, in conjunction with Central Office, determine activity priorities,
3
resources, and responsibilities. Contract staff conducting surveillance activities within
the regions will work under the direction of the Regional HPD.
SECTION 2: DETAILED SPECIFICATIONS
The contractor is required to recruit, organize and train sufficient staff to carry out
surveillance activities pursuant to this RFP across New York State as detailed below.
The contractor selected as a result of this RFP process will be required to perform all of
the following activities under the oversight and direction of the Department of Health.
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Receipt, Review, and Referral of Complaints and Incidents for Hospitals and
Diagnostic & Treatment Centers (Receipt, Review, Referral)
9
On-site routine surveys of Diagnostic & Treatment Centers (DTC Surveys)
9
On-site complaint/incident investigations of Hospitals and Diagnostic & Treatment
Centers (On-site Investigations)
9
Off-site complaint/incident investigations of Hospitals and Diagnostic & Treatment
Centers (Off-site Investigations)
9
NYPORTS Root Cause Analysis report reviews from Hospitals and Diagnostic &
Treatment Centers (RCA Reviews)
Bidders should submit a bid which encompasses the entirety of all activities. Activities
will be bid on a per unit price basis for the five units of activity as described above. The
details of what comprise the five units are listed below. These detailed lists include the
major components of the units, but are not meant to be all inclusive.
2.1 Receipt, Review and Referral of Complaints and Incidents for Hospitals and
Diagnostic & Treatment Centers (Receipt, Review, Referral)
2.1.1
Interact with possible complainants, mainly via calls to the toll-free hospital
and DTC complaint hotline; explain the complaint process, and forward
complaint forms as needed.
2.1.2
Maintain log of all contacts with possible complainants.
2.1.3
Receive and review patient care, environmental, and access complaint
allegations against Article 28 hospitals and DTCs received by telephone, mail,
email, or by any other means accepted by NYSDOH.
2.1.4
Contact possible complainants if additional information is needed.
2.1.5
Determine if complaint will be accepted for investigation.
2.1.6
Record all accepted complaints in ASPEN Complaint Tracking System
(ACTS) or other system designated by the Department and complete all
appropriate database activities associated with the complaint process.
4
2.1.7
Record all allegations received, which were determined to not rise to the level
of an investigable complaint (“non-complaints”), in a Microsoft Access
database.
2.1.8
Send correspondence to complainants.
2.1.9
Determine the priority of complaints.
2.1.10 Mediate those complaints simply requiring telephone contact(s) with the
facility or complainant for resolution.
2.1.11 Per DOH policies and procedures refer to Regional Offices those complaints
requiring on-site or off-site investigations.
2.1.12 Conduct tracking and trending of non-complaints for quality assurance
purposes.
2.1.13 Review all adverse events submitted through the New York Patient
Occurrence Reporting and Tracking System (NYPORTS).
2.1.14 Close all NYPORTS incidents not requiring any additional review.
2.1.15 Interact with facility NYPORTS coordinators to acquire additional information
as necessary.
2.1.16 Determine the level of investigation required (e.g., RCA review, off-site
investigation, on-site investigation) and refer to appropriate Regional Office.
2.1.17 On a monthly basis, monitor facility reporting compliance to determine which
facilities are out of compliance, draft Statements of Deficiencies to facilities in
violation, review facility Plans of Correction (POC), follow up with facilities as
needed, and draft POC acceptable letters.
2.1.18 Interact with Regional Office staff as needed.
2.1.19 As appropriate, make a referral to another Bureau within the Department, or
other State agency, according to NYSDOH policies and procedures (e.g.,
Office of Professional Medical Conduct, State Education Department, Centers
for Medicare and Medicaid Services).
2.1.20 Complete all appropriate database entry activities using relevant computer
systems.
2.1.21 Assist with the production, updating, and editing of Policy and Procedure
manuals related to centralized complaint unit activities.
2.1.22 Assist with the compilation of data in response to public and Departmental
requests regarding complaint/incident activities.
2.1.23 Assist the Department with the completion of tasks, as needed, to meet the
requirements of a comprehensive complaint and incident reporting program.
2.1.24 Provide management reports as needed by the Department including, at a
minimum, monthly and annual reports for informational needs.
2.1.25 Conduct internal quality improvement reviews to monitor program
performance, assure proficiency and promote efficiency.
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2.2 On-site routine surveys of Diagnostic & Treatment Centers (DTC Surveys)
2.2.1 In coordination with Regional Hospital Program Directors, prioritize and
schedule surveys of assigned facilities.
2.2.2 Conduct on-site investigations as described in the RFP and as directed by
Regional Office Hospital Program Directors. These surveys include, but are not
limited to: review of administration and governing body, review of personnel
issues including required training, credentialing, and health assessments,
review of facility policy and procedures including disaster preparedness
(emergency protocols) and quality assurance activities, observation of patient
care, tour of the physical plant to ensure services are being provided in a safe
environment and the setting is appropriate for services being provided, review a
sample medical records, and interact with staff.
2.2.3 Analyze survey findings and determine if the facility is in compliance with
applicable laws, rules and regulations.
2.2.4 If applicable, write a deficient practice statement which demonstrates specific
areas where the facility has failed to meet the requirements. Deficient practice
statements must be written using Principals of Documentation.
2.2.5 Follow prescribed protocols for follow-up and monitoring of deficiencies.
2.2.6 Complete all appropriate database entry activities associated with each of the
survey activities using relevant computer systems.
2.2.7 Conduct internal quality improvement reviews to monitor program performance,
assure proficiency and promote efficiency.
2.2 On-site investigations of Hospitals and Diagnostic & Treatment Centers (Onsite Investigations)
2.2.1 In coordination with Regional Hospital Program Directors, prioritize and
schedule investigations.
2.2.2 Conduct on-site focused investigations as described in the RFP and as directed
by Regional Office Hospital Program Directors. This may include, but not be
limited to: medical record review, interview of key staff, observation, review of
facility internal investigation and quality assurance reviews, and/or facility policy
and procedure review.
2.2.3 Interact with complainants and/or facility NYPORTS coordinators to acquire
additional information as necessary;
2.2.4 Analyze findings of investigation and determine if the facility is in compliance
with applicable laws, rules and regulations.
2.2.5 If applicable, write a deficient practice statement which demonstrates specific
areas where the facility has failed to meet the requirements. Deficient practice
statements must be written using Principals of Documentation.
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2.2.6 Follow prescribed protocols for follow-up and monitoring of deficiencies.
2.2.7 Complete all appropriate database entry activities associated with each of the
investigation activities using relevant computer systems.
2.2.8 Conduct internal quality improvement reviews to monitor program performance,
assure proficiency and promote efficiency.
2.3 Off-site investigations of Hospitals and Diagnostic & Treatment Centers (Offsite Investigations)
2.3.1 In coordination with Central Office management or Regional Hospital Program
Directors, prioritize investigations.
2.3.2 Conduct off-site focused investigations as described in the RFP and as directed
by Regional Office Hospital Program Directors. This may include, but not be
limited to: medical record review, interview of key staff, review of facility internal
investigation and quality assurance reviews, and/or facility policy and procedure
review.
2.3.3 Interact with complainants and/or facility NYPORTS coordinators to acquire
additional information as necessary;
2.3.4 Analyze findings of investigation and determine if the facility is in compliance
with applicable laws, rules and regulations.
2.3.5 If applicable, write a deficient practice statement which demonstrates specific
areas where the facility has failed to meet the requirements. Deficient practice
statements must be written using Principals of Documentation.
2.3.6 Follow prescribed protocol for follow-up and monitoring of deficiencies.
2.3.7 Complete all appropriate database entry activities associated with each of the
investigation activities using relevant computer systems.
2.3.8 Conduct internal quality improvement reviews to monitor program performance,
assure proficiency and promote efficiency.
2.4 NYPORTS Root Cause Analysis report reviews from Hospitals and Diagnostic
& Treatment Centers (RCA Reviews)
2.4.1 Read and assess facility-generated Root Cause Analysis (RCA) reports to
determine if the facility self-investigation was thorough and credible.
2.4.2 Interact with facility NYPORTS coordinators as necessary to ensure RCA is
thorough and credible.
2.4.3 Complete all appropriate database entry activities using relevant computer
systems.
2.4.4 Conduct internal quality improvement reviews to monitor program performance,
assure proficiency and promote efficiency.
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SECTION 3: WORKLOAD PROJECTIONS and DEFINITION of COMPLETED
SURVEILLANCE UNITS
An estimate of the number of, average hours required for, and region of the state for the
five defined units that must be completed annually over the five year contract period is
provided below. The anticipated workload is set forth under the following units:
1. Receipt, Review, Referral of Complaints and Incidents for Hospitals and DTCs
2. On-site routine surveys of DTCs
3. On-site complaint and incident investigations of Hospitals and DTCs
4. Off-site complaint and incident investigations of Hospitals and DTCs
5. NYPORTS Root Cause Analysis report reviews from Hospitals and Diagnostic &
Treatment Centers
These workload projections are based upon information available at the time of the RFP
issuance. These may change based upon review findings; changes in priorities;
changes in funding availability, etc. The workload estimates are being provided to
assist the bidder in the development of its Technical and Cost Proposal and should be
used by the bidder to:
o Estimate the personnel resources necessary to meet the State activity
requirements;
o Set a price for each defined unit and complete the cost proposal form as
requested in the cost section of the RFP (see Attachment 8: Cost Proposal
Form).
In estimating average hours to completion, the data takes into account historical and
anticipated variations including the possible need for multiple on-site visits, as well as
travel from the responsible regional office and administrative task time. A map and
listing of counties within each region and the office locations is provided to assist with
planning and bid preparation (Attachment 1).
1. Receipt, Review, and Referral of consumer complaints and facilityreported incidents related to Article 28 hospitals and diagnostic & treatment
centers; approximately 4,100 complaints/incidents per year, 2 hours per
complaint/incident, Central Office in Troy, NY.
Central Office
4,100 complaints/incidents
Completed unit: Referral to Regional Office or Closure of complaint/incident in
ASPEN, NYPORTS, and/or other system designated by the Department
8
NOTE: While the billable unit is the closure or referral of the complaint or
incident in ASPEN or NYPORTS, it should be noted that the toll-free line
receives over 900 contacts per month. The time necessary to effectively handle
all 11,000 contacts and the other activities the centralized unit undertakes (see
Section 2.1, Receipt, Review and Referral of Complaints and Incidents for
Hospitals and Diagnostic & Treatment Centers) is included in the average
number of hours per complaint/incident.
Additional work to be accomplished, which must be included in the unit bid
price is the monthly monitoring of NYPORTS reporting timeframe compliance,
including the issuance of Statements of Deficiencies (SODs) and review of
Plans of Correction. There are approximate 17 SODs per month (200 per year)
averaging 0.5 hours per SOD.
2. On-site routine surveys of Article 28 diagnostic & treatment centers;
approximately 45 surveys per year (at 73 sites), 50 hours per survey,
predominantly in the MARO region.
MARO: New York City
CDRO
WRO: Rochester
WRO: Buffalo
39 surveys (63 sites)
2 surveys (3 sites)
2 surveys (4 sites)
2 surveys (3 sites)
Completed unit: Closure of survey in ASPEN and/or other system designated
by the Department
3. On-site complaint and/or incident investigations of Article 28 hospitals and
diagnostic & treatment centers; approximately 165 surveys per year, 22.75
hours per survey, statewide.
MARO: New York City
MARO: New Rochelle
MARO: Long Island
CDRO
WRO: Rochester
WRO: Buffalo
50 surveys
15 surveys
15 surveys
28 surveys
28 surveys
28 surveys
Completed unit: Closure of survey in ASPEN, NYPORTS, and/or other system
designated by the Department
4. Off-site complaint and/or incident investigations of Article 28 hospitals and
diagnostic & treatment centers; approximately 450 surveys per year, 14.25
hours per survey, statewide.
9
MARO: New York City
MARO: New Rochelle
MARO: Long Island
CDRO
WRO: Rochester
WRO: Buffalo
Central Office
175 surveys
29 surveys
29 surveys
50 surveys
50 surveys
50 surveys
75 surveys
Completed unit: Closure of survey in ASPEN, NYPORTS, and/or other system
designated by the Department
5. NYPORTS Root Cause Analysis report reviews from Article 28 hospitals and
diagnostic & treatment centers; approximately 600 RCAs per year, 4 hours per
RCA, statewide.
MARO: New York City
MARO: New Rochelle
MARO: Long Island
CDRO
WRO: Rochester
WRO: Buffalo
Central Office
375 RCAs
15 RCAs
15 RCAs
50 RCAs
50 RCAs
50 RCAs
50 RCAs
Completed unit: Closure of incident in NYPORTS and/or other system
designated by the Department
Below is a table showing the projected workload by type of surveillance activity and
Regional Office location.
Office Location
MARO: New York City
MARO: New Rochelle
MARO: Long Island
CDRO
WRO: Rochester
WRO: Buffalo
Central Office
Estimated volume of activity
Receipt,
Review,
Referral
0
0
0
0
0
0
4100
DTC
Onsite
39
0
0
2
2
2
0
Onsite
Investigation
50
15
15
28
28
28
0
Offsite
Investigation
175
29
29
50
50
50
75
RCA
Review
375
15
15
50
50
50
50
4100
45
164
458
605
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SECTION 4: STAFFING REQUIREMENTS and TRAINING
The contractor shall assure that sufficient personnel are hired and on staff to perform
the activities as described in this document and consistent with the cost proposal for this
contract.
At a minimum Registered Professional Nurses are required to perform the
complaint/incident reviews and referrals, the on-site and off-site surveys/investigations,
RCA reviews, and supervise the intake unit. All Contractor staff conducting on-site and
off-site surveys/investigations must provide proof of having completed, or complete
within three months of hire, Web-based Principles of Documentation (12 hours);
Survey Nurses
Mandatory Requirements
•
Registered Professional Nurse currently licensed in New York;
•
Excellent telephone and written communication skills;
•
Basic computer skills;
Supervisor Nurse
A supervising nurse is required to oversee the day-to-day operations of the contractor
staff performing functions assigned to Central Office, train this staff as needed, and
participate in regularly scheduled and unscheduled Central Office meetings.
Mandatory Requirements
Registered Professional Nurse currently licensed in New York;
•
3-5 years management experience in a health care setting;
•
Excellent telephone and written communication skills;
•
Basic computer skills;
•
Support Staff
One support staff person is required in the Central Office contractor staff unit and one
support staff person is required in the New York City Metropolitan Area Office. All
support staff must be included in the bid price(s) and such staff should meet the
following requirements:
Mandatory Requirement
Working knowledge of all Microsoft Office products.
•
SECTION 5: NYSDOH RESPONSIBILITIES
•
•
•
Office space for Contractor staff at the Department’s appropriate Regional Offices
and in Central Office;
Office furniture;
Office supplies;
11
•
•
•
•
•
•
•
•
•
•
In-office communication equipment and services, including telephones, fax
machines, personal computers and printers;
Computer support services;
Telephone support services in the Regional Offices only.
Training of contract staff on appropriate computer/data systems at start-up and as
needed to facilitate contractor training initiatives;
Training of contract staff in internal processes;
Providing an overview of relevant regulations and interpretation of such;
Sign-off on completed units;
Evaluation and monitoring of contractor to determine contractor’s success in the
performance of the activities set forth in this RFP. This evaluation will include:
o
Ability to work cooperatively with the Department including
responsiveness and flexibility;
o
The timely and effective performance of the activities required in the RFP
including the accuracy of its survey/investigation findings;
o
The accurate and timely reporting of findings to the Department.
NYSDOH reserves the right to terminate the project at any given time, either prior to
award or after, based on conditions/situations including but not limited to:
o
Budgetary constraints
o
Change in agency priorities
o
Contractor’s failure to provide satisfactory performance by its consultants
as determined by the NYSDOH project manager
o
The acquisition of additional in-house resources
Work performed beyond the scope of this contract without prior written approval will
not be compensated.
SECTION 6: CONTRACTOR RESPONSIBILITIES
•
The Contractor must include in its Unit prices for each of the five activities all costs
including:
o
All staff performing functions related to the units;
o
Travel, including travel to facilities for the purpose of on-site
surveys/investigations, routine commuting costs if the Bidder reimburses
its staff for such expenses, travel for training and/or off-site meetings
required by the Department, or other travel required by the terms of any
contract awarded;
o
Training costs other than training provided directly by NYSDOH staff;
o
Creating a claim or voucher under the contract;
o
Attending meetings with the Department related to the contract;
•
All Contractor staff conducting on-site and off-site surveys/investigations must
provide proof of having completed, or complete within three months of hire Webbased Principles of Documentation (12 hours);
•
As appropriate, Contractor staff must participate in:
o
Department training, if available (up to 15 hours annually, plus travel time
if any);
12
o
o
o
Department and any federal training related to Health Insurance Portability
and Accountability Act (HIPAA) confidentiality and compliance;
Department Bureau & Division meetings (approximately 75 hours
annually)
Attend appropriate Surveillance Training Academy sessions
(approximately 15 hours, via Webinar);
•
The Consultant will maintain appropriate staffing levels throughout the course of the
contract. Changes in staff will have to be approved by the NYSDOH. Any
replacement staff must have comparable skills;
•
The contractor must conduct internal quality improvement reviews to monitor
program performance, assure proficiency and promote efficiency.
SECTION 7: PROPOSAL REQUIREMENTS
Proposals will only be accepted from public or private organizations, companies,
partnerships, or corporations that are authorized to operate in New York State. Such
organization and its subsidiaries may not be a provider of health care services, a health
care facility accrediting body or organization or trade association whose primary
business includes representing any Article 28 licensed provider. Eligible organizations
must have the expertise and capacity to carry out the surveillance activities on a
statewide basis, as described in this RFP.
There will be no Bidders Conference. All Questions must be submitted in writing by the
date specified on the Schedule of Key Events. Question should be emailed to
[email protected] with the subject “Surveillance RFP – FAU# 1005101128”.
The Department will then post all Questions and Answers on the NYSDOH website
(www.nyhealth.gov/funding/). This Q&A document will also be mailed to all potential
bidders who have either submitted a Notice of Intent to Submit or have requested in
writing such information.
Bidders must not include any contingencies in the proposal. All proposals including
contingencies will be rejected. Areas needing clarification must be addressed via the
Question and Answer mechanism discussed above.
Proposals submitted should be complete responses to this RFP and be as clear and
concise as possible. The bidder bears the sole responsibility for any costs incurred as a
result of developing a response to this RFP.
7.1 Technical Proposal Requirements (70%)
The proposal with the highest technical score will receive the maximum point score, and
other bidders will receive a normalized score (bidder’s points/highest points x 70). The
bidder will be evaluated on the quality of the methods/systems proposed to conduct all
required activities to assist with a statewide surveillance system. Specific attention will
13
be given to steps taken to ensure the continuity of functions while carrying out the
program among facilities, by region and on a statewide basis.
7.1.1 Project Narrative
The bidder will be expected to have knowledge and understanding of the
regulatory and health care environment in which the surveillance activities
take place, including issues and obstacles associated with operating such
program in New York State. Reference should be made to bidders
understanding of HIPAA and Medicare/Medicaid privacy and confidentiality
requirements. Bidders should also submit a brief description of bidder’s skills,
experience and qualifications in assessing the care provided by healthcare
providers and providers’ compliance with laws and regulations, including the
number of years of experience with different types of surveillance activities.
The bidder will be judged on the extent to which the proposal reflects such
knowledge and experience.
The bidder must set forth in detail how it proposes to implement the
responsibilities set forth in Section 2, Detailed Specifications, and Section 3,
Workload Projections and Definition of Completed Surveillance Units, and
shall confirm that the proposal submitted will fulfill all statewide requirements
as described in the RFP. The proposal is expected to include a clear, concise
narrative for describing how the bidder will carry out the overall project. This
should include reference to any experience carrying out the delineated
activities in New York State or elsewhere. The bidder must provide evidence
of the organization’s ability and capacity to implement the program and carry
out the projected workload on a statewide and regionalized basis for each
contract year. The proposal must also document the mechanism for
monitoring performance of staff, effectiveness of processes, timeliness of
processing and the oversight and management of a statewide surveillance
operation. Additionally, the narrative should include reference to any
experience the bidder may have with Department and/or Federal surveillance
reporting systems such as ASPEN (ACO and ACTS) and NYPORTS.
7.1.2 Organization and Staffing
The bidder must describe the recruitment and training efforts that will be put
in place to provide for an adequate number of appropriately trained and
qualified individuals to carry out the goals and responsibilities of the RFP.
See Section 4, Staffing Requirements and Training for mandatory staff and
credentials. Such efforts must provide for the conduct of a statewide
program, operated on a regionalized format and must ensure that the staffing
needs of the program are met on an ongoing basis. Each proposal must
provide assurance that staffing and resource allocations promote continuity of
function in program activities and monitoring responsibilities.
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Detailed information and explanations must be provided to document how the
proposed work will be carried out. The bidder’s proposal will be judged on the
staffing plan provided to meet program goals. Describe how staff, including
sub-contractor staff if any, will be organized, distributed, and managed to
ensure appropriate communication, supervision and authority to complete all
work in a timely fashion, as well as ensure that resources are available
throughout the State to staff this statewide initiative. The bidder must include
a description of the anticipated distribution of staff, by DOH office location, to
ensure appropriate coverage of the surveillance activities required, as
specified in Section 3, Workload Projections and Definition of Completed
Surveillance Units. The bidder should also address how variations in
workload, by region, throughout the year will be handled. Include brief
profiles of key staff that state why each individual’s skills and experiences are
significant to effective performance and timely deliverables. Any subcontractors must be listed and are subject to DOH approval. Please include
vita, resumes, licenses and certifications as a separate section of the
proposal (see Section 9.1, Technical Proposal Formatting).
7.2 Cost Proposal Requirements (30%)
Price will be a significant consideration in the selection of qualifying proposals, but the
award will not necessarily be made to the bidder with the lowest price.
Information must be provided in detail sufficient to document how the total dollar/cost
proposal was determined and how costs are aligned to the five (5) distinct surveillance
activities to be performed. Cost must be clearly identified for each contract year.
The total annual cost of implementing and operating this statewide surveillance program
will be distributed among the number of units of activity completed each year, in
accordance with the estimates provided in this RFP. The volume in each category of
surveillance has the potential to vary yearly based upon the needs of the State.
Payment will be made for the delineated units only and these per unit costs will be allinclusive costs. These all-inclusive costs must include direct and indirect costs
including the administrative cost of organizing, implementing, and carrying out the
required activities.
The bidder is expected to submit a firm fixed cost for each delineated unit for each
contract year of the five year contract. All costs for implementing this statewide
program will be distributed among the billable units only.
• Only activities approved by the Department during each billing cycle will be
subject to payment. Department approval is subject to successful completion of
each unit as defined in Section 3, Workload Projections and Definition of
Completed Surveillance Units.
15
•
Total cost of implementing and operating this program must include staff and
resources sufficient to carry out a statewide surveillance system as described in
this RFP.
SECTION 8: METHOD of AWARD
This section details criteria to be used for evaluation of proposals submitted in response
to the RFP for State Surveillance Activities for Hospitals and Diagnostic & Treatment
Centers. At the discretion of the Department of Health, all bids may be rejected. The
following criteria will serve as the basis of review and each proposal eligible for review
will receive a numerical score based upon the values associated with the criteria listed
below.
8.1
Conflict of Interest (Pass / Fail)
Bidders must demonstrate to the Department that they have no real or perceived
conflict of interest with respect to conducting the duties and responsibilities in this
RFP. The Department reserves the right to disqualify any organization that is not
able to sufficiently demonstrate that it is free of any real or perceived conflict of
interest.
8.2
Scope of Proposal (Pass / Fail)
Proposals that fail to provide for a statewide surveillance system will not be
reviewed further and will not receive a numerical score.
8.3
Mandatory Staff (Pass / Fail)
Proposals that fail to provide mandatory staff with mandatory credentials, as
described in Section 4: Staffing requirements and Training will not be reviewed
further and will not receive a numerical score.
8.4
Financial Feasibility (Pass / Fail)
Proposals that fail to demonstrate financial strength and stability sufficient to
carry out the requirements of the RFP will not be reviewed further and will not
receive a numerical score.
8.5
Technical Proposal (70%)
The proposal with the highest technical score will receive the maximum point
score, and other bidders will receive a normalized score (bidder’s points/highest
points x 70).
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The bidder will be evaluated on the quality of the methods/systems proposed to
conduct all required activities to assist with a statewide surveillance system.
8.6
Cost Proposal (30%)
The cost proposal of each bidder will be evaluated separately from the technical
proposal. The bidder is expected to submit a firm fixed price for each bidding
unit of activity for each year of the five year contract.
The proposal with the lowest cost proposal will receive the maximum point score,
and the other bidders will receive a normalized score (lowest cost/bidder’s cost x
30).
The Cost Proposal Form (Attachment 8) is the sole “scoreable” component of the
cost proposal.
SECTION 9: PROPOSAL SUBMISSION and FORMATTING REQUIREMENTS
Responses to this solicitation should be clearly marked as “RFP-Statewide Surveillance
Activities for Hospitals and Diagnostic & Treatment Centers – FAU #1005101128” and
must be received by 3p.m., on October 4, 2010, at the following address:
Division of Certification & Surveillance
New York State Department of Health
433 River Street – 6th Floor
Troy, New York 12180
Attention: Barbara DelCogliano
It is the bidders’ responsibility to see that bids are delivered to Division of Certification &
Surveillance, 6th Floor, prior to the date and time of the bid due date. Late bids due to
delay by the carrier or not received in the Department’s mail room in time for
transmission to Division of Certification & Surveillance, 6th Floor, will not be considered.
The proposal must be submitted in two parts and in two separately sealed envelopes
that must then be placed in a third envelope when mailed to avoid separation. The two
parts are a Technical Proposal and a Cost Proposal. It is important that no information
related to the proposal price be included in the Technical Proposal. Bidders should
ensure that their proposal includes all required sections. Failure to submit a complete
proposal may result in disqualification. The proposal must be submitted using a font
size no smaller than 10 point and no larger than 14 point. All proposal pages should be
numbered.
Both hardcopy and electronic versions of the bid must be submitted. Signed
hardcopies should include one (1) original and five (5) copies of the Technical proposal
17
and one (1) original and five (5) copies of the Cost proposal. The electronic copy of the
bid should be submitted on two CD/DVDs – one for the Technical proposal and one for
the Cost proposal.
The original and all copies of the Technical Proposal should be placed in a separate
envelope, along with the Technical CD/DVD and clearly marked:
New York State Department of Health
Hospital and DTC Surveillance – Technical Proposal
(Bidder’s Name)
The original and all copies of the Cost Proposal should be placed in a separate
envelope, along with the Cost CD/DVD and clearly marked:
New York State Department of Health
Hospital and DTC Surveillance – Cost Proposal
(Bidder’s Name)
The separately sealed Technical Proposal and the separately sealed Cost Proposal
should be submitted together in a third envelope to prevent separation during transit.
The Technical proposal should consist of seven (7) sections, presented in the following
order:
1. Proposal Cover Sheet (Attachment 4)
2. Table of Contents
3. Bidder Qualifications
4. Project Narrative
5. Organization and Staffing
6. Vita, Resumes, Licenses and Certifications
7. Bidder’s Assurances (Attachment 7)
The Financial Proposal should include seven (7) separate sections, presented in the
following order:
1. Bid Form (Attachment 6)
2. Cost Proposal Forms (Attachment 8)
3. Proof of incorporation and financial viability
4. Vendor Responsibility Attestations (Attachment 9)
5. State Consultant Services Forms (Attachment 10)
6. New York State Taxation and Finance Forms – ST-220-TD and ST-220-CA
(Attachment 11)
7. Minority and/or Women Owned Business Enterprises (M/WBE) Utilization Plan
(Attachment 14)
9.1
Technical Proposal Formatting
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9.1.1 Proposal Cover Sheet
Please submit a completed proposal cover sheet shown in Attachment 4
9.1.2 Table of Contents
Include a Table of Contents that delineates all major headings and subheadings. Number all pages consecutively, including forms and attachments.
9.1.3 Bidder Qualifications
The Department will accept proposals only from public or private
organizations, companies, partnerships, or corporations that are authorized to
operate in New York State. Such organization and its subsidiaries may not
be a provider of health care services, a health care facility accrediting body or
any organization or trade association whose primary business includes
representing any Article 28 licensed provider. Eligible organizations must
have the expertise and capacity to carry out the surveillance activities on a
statewide basis, as described in this RFP. Responsibility rests solely with
the bidder to demonstrate to the Department that the potential contractor has
no real or perceived conflict of interest with respect to conducting the duties
and responsibilities of the RFP. The Department reserves the right to
disqualify any organization that is not able to sufficiently demonstrate that it is
free of any real or perceived conflict of interest.
9.1.4 Project Narrative
Refer to Section 7.1, Technical Proposal Requirements for the required
elements.
9.1.5 Organization and Staffing
Refer to Section 7.1, Technical Proposal Requirements for the required
elements.
9.1.6 Vita, Resumes, Licenses and Certifications
Include resumes, licenses and certifications for key project staff in a
separately tabbed section of the Technical Proposal.
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9.1.7 Bidder’s Assurances – Attachment 7
This form must accompany the Technical Bid and be signed on behalf of the
bidder by an authorized individual who attests that the assurances are true
and accurate.
9.2
Cost Proposal Formatting
9.2.1 Bid Form – Attachment 6
This form must accompany the Cost Proposal. It presents the total bid price
and includes questions on prior non-responsibility, procurement terminations
or withholds of the bidder and certifies that all information is complete and
accurate. Please note: The total bid is each of the five year’s unit bids
multiplied by the corresponding estimated annual volumes, summed.
9.2.2 Cost Proposal Form – Attachment 8
Based upon the projected workload outlined in Section 3, Workload
Projections and Definition of Completed Surveillance Units, the bidder must
complete and supply any narrative explanation considered necessary and
appropriate to assist the Department in its understanding and evaluation of
the financial data provided in the Cost Proposal Form set forth in Attachment
8. This form is used to present the bidder's fixed price bid for the required
deliverables. Unit prices and total dollars requested are to be provided for the
activities listed. Since this is a price contract, not a cost contract, indirect
costs should be included in the unit prices. This information will be used to
score the bidder Cost Proposal. Please note: The total bid is each of the
five year’s unit bids multiplied by the corresponding estimated annual
volumes, summed.
9.2.3 Proof of Incorporation and Financial Viability
The financial and cost proposal information must include proof of
incorporation and financial viability i.e. independent financial audits; Dunn and
Bradstreet reports etc. This information should include if available a minimum
of three (3) most recent years of audited financial statements. It is the
bidder’s responsibility to demonstrate financial capability to the satisfaction of
the State. If bidder proposes the use of consultants or subcontractors the
proposal must include proof of incorporation and financial viability for any and
all consultants/subcontractors as well.
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Bidders must pass an evaluation of financial strength in order to be scored. A
bidder’s financial strength and stability, along with that of any proposed
subcontractors, will be examined to ensure sufficient assets are available to
perform the magnitude of services required. The State reserves the right to
make a judgment regarding the financial viability of an organization to
implement and carry out the responsibilities set forth in the RFP.
9.2.4 Vendor Responsibility Questionnaire and Attestation – Attachment 9
New York State Procurement Law requires that state agencies award contracts
only to responsible vendors. Vendors are invited to file the required Vendor
Responsibility Questionnaire online via the New York State VendRep System or
may choose to complete and submit a paper questionnaire. To enroll in and
use the New York State VendRep System, see the VendRep System
Instructions available at www.osc.state.ny.us/vendrep or go directly to the
VendRep system online at https://portal.osc.state.ny.us. For direct VendRep
System user assistance, the OSC Help Desk may be reached at 866-370-4672
or 518-408-4672 or by email at [email protected]. Vendors opting to
file a paper questionnaire can obtain the appropriate questionnaire from the
VendRep website www.osc.state.ny.us/vendrep or may contact the Department
of Health or the Office of the State Comptroller for a copy of the paper form.
Bidders must also complete and submit the Vendor Responsibility Attestation
(Attachment 9).
9.2.5 State Consultant Services Forms - Attachment 10
Chapter 10 of the Laws of 2006 amended certain sections of State Finance
Law and Civil Service Law to require disclosure of information regarding
contracts for consulting services in New York State.
The winning bidders for procurements involving consultant services must
complete a "State Consultant Services Form A, Contractor's Planned
Employment From Contract Start Date through End of Contract Term" in
order to be eligible for a contract.
Winning bidders must also agree to complete a "State Consultant Services
Form B, Contractor's Annual Employment Report" for each state fiscal year
included in the resulting contract. This report must be submitted annually to
the Department of Health, the Office of the State Comptroller, and
Department of Civil Service.
Both of these forms are included as attachments to this document.
Form A of the State Consultant Services Forms should be completed as a
part of the original bid proposal. The report is submitted only to the soliciting
agency who will in turn submit the report to the NYS Office of the State
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Comptroller. Form B is completed annually for the period April 1 through
March 31 and must be submitted by May 15th of each year of the contract
(see Instructions in Attachment 10).
9.2.6 New York State Taxation and Finance Forms - Attachment 11
The bidder’s cost proposal should include a copy of both the New York State
Taxation and Finance Form ST-220-TD – Contractor Certification (Attachment
9) that was submitted to the New York State Department of Taxation and
Finance and State Taxation and Finance Form ST-220-CA – Contractor
Certification to Covered Agency (Attachment 11). Both forms will become
part of the successful bidder’s contract.
9.2.7 M/WBE Utilization Plan for Subcontracting and Purchasing Attachment 14
The Department of Health (DOH) encourages the use of Minority and/or
Women Owned Business Enterprises (M/WBE's) for any subcontracting or
purchasing related to this contract. Bidders who are not currently a New York
State certified M/WBE must define the portion of all consumable products and
personnel required for this proposal that will be sourced from a M/WBE. The
amount must be stated in total dollars and as a percent of the total cost
necessary to fulfill the RFP requirement. Supportive documentation must
include a detail description of work that is required including products and
services.
The goal for usage of M/WBE's is at least 10% of monies used for contract
activities (Minority-owned – 5%; Women-owned – 5%). In order to assure a
good-faith effort to attain this goal, the DOH requires that bidders complete
the M/WBE Utilization Plan (Attachment 14) and submit this Plan with their
bid documents.
Bidders that are New York State certified MBE's or WBE's are not required to
complete this form. Instead, such bidders must simply provide evidence of
their certified status.
Failure to submit the above referenced Plan (or evidence of certified M/WBE
status) may result in disqualification of the vendor from consideration for
award.
9.3 Formatting Deductions
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Each proposal must comply with the following format requirements. Failure to do
so will result in the deduction of points for formatting irregularities. A total of four
(4) points may be deducted for this reason. Formatting requirements include:
1. Each proposal submitted must include two separate and separately sealed
components: a Technical Proposal and a Cost Proposal,
2. An original and five (5) signed copies of the Technical Proposal as well as an
original and five (5) signed copies of the Cost Proposal should be submitted,
3. Electronic submission of bid should be submitted on two CDs or DVDs – one
for the Technical Proposal and one for the Financial Proposal,
4. The “Vendor Responsibility Attestation” (Attachment 9) must be fully completed
by the bidder and submitted as part of the Cost Proposal.
5. All copies of the Technical Proposal must be organized and submitted with tab
dividers identifying each section of the proposal,
6. The pages of the Technical Proposal must be clearly numbered and identified
in a Table of Contents,
7. Technical and Cost Proposals must be prepared and submitted with letter size
(8.5x11) paper, and
8. The Technical Proposal and the Cost Proposal must be prepared with
appropriate type size (no smaller than 10 point and no larger than 14 point).
SECTION 10: ADMINISTRATIVE
10.1
Issuing Agency
This Request for Proposal (RFP) is a solicitation issued by the New York State
Department of Health. The Department is responsible for the requirements
specified herein and for the evaluation of all proposals. Only those bidders who
furnish a complete proposal will be considered for evaluation. A contract will be
awarded to a single contractor selected by the Department.
10.2
Bidders’ Conference / Inquiries
There will be no Bidders Conference. Any and all Questions regarding this RFP
must be submitted in writing and must be received by 3:00 pm on the date
specified on the Schedule of Key Events. Question should be emailed to
[email protected] with the subject “Surveillance RFP – FAU
#1005101128”. Questions may also be mailed to:
Barbara DelCogliano
Division of Certification & Surveillance
23
New York State Department of Health
433 River Street – 6th Floor
Troy, New York 12180
The Department will then post all responses to all questions received by the due
date on the NYSDOH website (www.nyhealth.gov/funding/). This document will
also be emailed or mailed to all potential bidders who have either submitted a
Notice of Intent to Submit or have requested in writing such information.
10.3
THE DEPARTMENT OF HEALTH RESERVES THE RIGHT TO:
1. Reject any or all proposals received in response to the RFP;
2. Withdraw the RFP at any time, at the agency’s sole discretion;
3. Make an award under the RFP in whole or in part;
4. Disqualify any bidder whose conduct and/or proposal fails to conform to the
requirements of the RFP;
5. Seek clarifications and revisions of proposals;
6. Use proposal information obtained through site visits, management interviews
and the state’s investigation of a bidder’s qualifications, experience, ability or
financial standing, and any material or information submitted by the bidder in
response to the agency’s request for clarifying information in the course of
evaluation and/or selection under the RFP;
7. Prior to the bid opening, amend the RFP specifications to correct errors or
oversights, or to supply additional information, as it becomes available;
8. Prior to the bid opening, direct bidders to submit proposal modifications
addressing subsequent RFP amendments;
9. Change any of the scheduled dates;
10. Eliminate any mandatory, non-material specifications that cannot be complied
with by all of the prospective bidders;
11. Waive any requirements that are not material;
12. Negotiate with the successful bidder within the scope of the RFP in the best
interests of the state;
13. Conduct contract negotiations with the next responsible bidder, should the
agency be unsuccessful in negotiating with the selected bidder;
14. Utilize any and all ideas submitted in the proposals received;
15. Unless otherwise specified in the solicitation, every offer is firm and not
revocable for a period of 60 days from the bid opening; and,
16. Require clarification at any time during the procurement process and/or
require correction of arithmetic or other apparent errors for the purpose of
24
assuring a full and complete understanding of an bidder’s proposal and/or to
determine an bidder’s compliance with the requirements of the solicitation.
10.4
Payment
If awarded a contract, the contractor shall submit invoices to the State’s
designated payment office:
Division of Certification & Surveillance
New York State Department of Health
433 River Street – 6th Floor
Troy, New York 12180
Payment for invoices and/or vouchers submitted by the CONTRACTOR shall
only be rendered electronically unless payment by paper check is expressly
authorized by the Commissioner, in the Commissioner's sole discretion, due to
extenuating circumstances. Such electronic payment shall be made in
accordance with ordinary State procedures and practices. The CONTRACTOR
shall comply with the State Comptroller's procedures to authorize electronic
payments. Authorization forms are available at the State Comptroller's website
at www.osc.state.ny.us/epay/index.htm, by email at [email protected] or by
telephone at 518-474-6019. CONTRACTOR acknowledges that it will not
receive payment on any invoices and/or vouchers submitted under this Contract
if it does not comply with the State Comptroller's electronic payment procedures,
except where the Commissioner has expressly authorized payment by paper
check as set forth above.
In addition to the Electronic Payment Authorization Form, a Substitute Form W-9
must be on file with the Office of the State Comptroller, Bureau of Accounting
Operations. Additional information and procedures for enrollment can be found
at http://www.osc.state.ny.us/epay.
Completed W-9 forms should be submitted to the following address:
NYS Office of the State Comptroller
Bureau of Accounting Operations
Warrant & Payment Control Unit
110 State Street, 9th Floor
Albany, NY 12236
Payment of such invoices and/or vouchers by the State (NYS Department of
Health) shall be made in accordance with Article XI-A of the New York State
Finance Law. Payment terms will be:
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Payment will be made based upon vouchers submitted each month documenting
the number of completed units conducted. A completed unit is defined in Section
3, Workload Projections and Definition of Completed Surveillance Units and
approval by Department staff.
10.5 Term of Contract
This agreement shall be effective upon approval of the NYS Office of the State
Comptroller. The contract resulting from this RFP is expected to be for the period
January 1, 2011 to December 31, 2015.
This agreement may be canceled at any time by the Department of Health giving to
the contractor not less than thirty (30) days written notice that on or after a date
therein specified this agreement shall be deemed terminated and canceled.
10.6
Debriefing
Once an award has been made, bidders may request a debriefing of their proposal.
Please note the debriefing will be limited only to the strengths and weaknesses of
the bidder’s proposal, and will not include any discussion of other proposals.
Requests must be received no later than three months from date of award
announcement.
10.7
Protest Procedures
In the event unsuccessful bidders wish to protest the award resulting from this RFP,
bidders should follow the protest procedures established by the Office of the State
Comptroller (OSC). These procedures can be found on the OSC website at:
http://www.osc.state.ny.us/agencies/gbull/g_232.htm.
10.8
Lobbying Statute
Chapter 1 of the Laws of 2005, as amended by Chapter 596 of the Laws of 2005,
provides, among other things, the following as pertains to development of
procurement contracts with governmental entities:
a.
makes the lobbying law applicable to attempts to influence procurement
contracts once the procurement process has been commenced by a state
agency, unified court system, state legislature, public authority, certain
industrial development agencies and local benefit corporations;
b.
requires the above mentioned governmental entities to record all contacts
made by lobbyists and contractors about a governmental procurement so
26
that the public knows who is contacting governmental entities about
procurements;
c.
requires governmental entities to designate persons who generally may be
the only staff contacted relative to the governmental procurement by that
entity in a restricted period;
d.
authorizes the New York State Commission on Public Integrity to impose
fines and penalties against persons/organizations engaging in impermissible
contacts about a governmental procurement and provides for the debarment
of repeat violators;
e.
directs the Office of General Services to disclose and maintain a list of nonresponsible bidders pursuant to this new law and those who have been
debarred and publish such list on its website;
f.
requires the timely disclosure of accurate and complete information from
offerers with respect to determinations of non-responsibility and debarment;
g.
expands the definition of lobbying to include attempts to influence
gubernatorial or local Executive Orders, Tribal–State Agreements, and
procurement contracts;
h.
modifies the governance of the New York State Commission on Public
Integrity
i.
provides that opinions of the Commission shall be binding only on the
person to whom such opinion is rendered;
j.
increases the monetary threshold which triggers a lobbyists obligations
under the Lobbying Act from $2,000 to $5,000; and
k.
establishes the Advisory Council on Procurement Lobbying.
Generally speaking, two related aspects of procurements were amended: (i)
activities by the business and lobbying community seeking procurement
contracts (through amendments to the Legislative Law) and (ii) activities involving
governmental agencies establishing procurement contracts (through
amendments to the State Finance Law).
Additionally, a new section 1-t was added to the Legislative Law establishing an
Advisory Council on Procurement Lobbying (Advisory Council). This Advisory
Council is authorized to establish the following model guidelines regarding the
restrictions on contacts during the procurement process for use by governmental
entities (see Legislative Law §1-t (e) and State Finance Law §139-j). In an effort
to facilitate compliance by governmental entities, the Advisory Council has
prepared model forms and language that can be used to meet the obligations
imposed by State Finance Law §139-k, Disclosure of Contacts and Responsibility
of Offerers. Sections 139-j and 139-k are collectively referred to as “new State
Finance Law.”
27
It should be noted that while this Advisory Council is charged with the
responsibility of providing advice to the New York State Commission on Public
Integrity regarding procurement lobbying, the Commission retains full
responsibility for the interpretation, administration and enforcement of the
Lobbying Act established by Article 1-A of the Legislative Law (see Legislative
Law §1-t (c) and §1-d). Accordingly, questions regarding the registration and
operation of the Lobbying Act should be directed to the New York State
Commission on Public Integrity.
10.9
Accessibility of State Agency Web-based Intranet and Internet Information
and Applications
Any web-based intranet and internet information and applications development, or
programming delivered pursuant to the contract or procurement will comply with
New York State Enterprise IT Policy NYS-P08-005, “Accessibility Web-based
Information and Applications”, and New York State Enterprise IT Standard NYSS08-005, Accessibility of Web-based Information Applications, as such policy or
standard may be amended, modified or superseded, which requires that state
agency web-based intranet and internet information and applications are accessible
to persons with disabilities. Web content must conform to New York State
Enterprise IT Standard NYS-S08-005, as determined by quality assurance testing.
Such quality assurance testing will be conducted by Department of Health,
contractor or other, and the results of such testing must be satisfactory to the
Department of Health before web content will be considered a qualified deliverable
under the contract or procurement.
10.11 Information Security Breach and Notification Act
Section 208 of the State Technology Law (STL) and Section 899-aa of the General
Business Law (GBL) require that State entities and persons or businesses
conducting business in New York who own or license computerized data which
includes private information including an individual’s unencrypted personal
information plus one or more of the following: social security number, driver’s
license number or non-driver ID, account number, credit or debit card number plus
security code, access code or password which permits access to an individual’s
financial account, must disclose to a New York resident when their private
information was, or is reasonably believed to have been, acquired by a person
without valid authorization. Notification of breach of that private information to all
individuals affected or potentially affected must occur in the most expedient time
possible without unreasonable delay, after measures are taken to determine the
scope of the breach and to restore integrity; provided, however, that notification
may be delayed if law enforcement determines that expedient notification would
impede a criminal investigation. When notification is necessary, the State entity or
person or business conducting business in New York must also notify the following
28
New York State agencies: the Attorney General, the Office of Cyber Security &
Critical Infrastructure Coordination (CSCIC) and the Consumer Protection Board
(CPB). Information relative to the law and the notification process is available at:
http://www.cscic.state.ny.us/security/securitybreach/
10.12 New York State Tax Law Section 5-a
Section 5-a of the Tax Law, as amended, effective April 26, 2006, requires certain
contractors awarded state contracts for commodities, services and technology
valued at more than $100,000 to certify to the Department of Tax and Finance
(DTF) that they are registered to collect New York State and local sales and
compensating use taxes. The law applies to contracts where the total amount of
such contractors’ sales delivered into New York State are in excess of $300,000 for
the four quarterly periods immediately preceding the quarterly period in which the
certification is made, and with respect to any affiliates and subcontractors whose
sales delivered into New York State exceeded $300,000 for the four quarterly
periods immediately preceding the quarterly period in which the certification is
made.
This law imposes upon certain contractors the obligation to certify whether or not
the contractor, its affiliates, and its subcontractors are required to register to collect
state sales and compensating use tax and contractors must certify to DTF that each
affiliate and subcontractor exceeding such sales threshold is registered with DTF to
collect New York State and local sales and compensating use taxes. The law
prohibits the State Comptroller, or other approving agencies, from approving a
contract awarded to an offerer meeting the registration requirements but who is not
so registered in accordance with the law.
Contractor must complete and submit directly to the New York State Taxation and
Finance, Contractor Certification Form ST-220-TD attached hereto. Unless the
information upon which the ST-220-TD is based changes, this form only needs to
be filed once with DTF. If the information changes for the contractor, its affiliate(s),
or its subcontractor(s), a new form (ST-220-TD) must be filed with DTF.
Contractor must complete and submit to the Department of Health the form ST220-CA attached hereto, certifying that the contractor filed the ST-220-TD with
DTF. Failure to make either of these filings may render an offerer non-responsive
and non-responsible. Offerers shall take the necessary steps to provide properly
certified forms within a timely manner to ensure compliance with the law.
10.13 Piggybacking
New York State Finance Law section 163(10)(e) (see also
http://www.ogs.state.ny.us/procurecounc/pgbguidelines.asp) allows the
29
Commissioner of the NYS Office of General Services to consent to the use of this
contract by other New York State Agencies, and other authorized purchasers,
subject to conditions and the Contractor’s consent.
SECTION 11: CONTRACT APPENDICES
The following will be incorporated as appendices into any contract resulting from this
Request for Proposal. This Request for Proposal will, itself, be referenced as an appendix
of the contract.
‰
APPENDIX A - Standard Clauses for All New York State Contracts
‰
APPENDIX B - Request for Proposal
‰
APPENDIX C - Proposal
The bidder's proposal (if selected for award), including any Bid Forms and all
proposal requirements.
‰
APPENDIX D - General Specifications
‰
APPENDIX E
Unless the CONTRACTOR is a political sub-division of New York State, the
CONTRACTOR shall provide proof, completed by the CONTRACTOR's
insurance carrier and/or the Workers' Compensation Board, of coverage for:
‰
Workers' Compensation, for which one of the following is incorporated into
this contract as Appendix E-1:
o CE-200, Affidavit For New York Entities And Any Out-Of-State Entities
With No Employees, That New York State Workers’ Compensation
And/Or Disability Benefits Insurance Coverage Is Not Required; OR
o C-105.2 – Certificate of Workers’ Compensation Insurance. PLEASE
NOTE: The State Insurance Fund provides its own version of this form,
the U-26.3; OR
o SI-12 – Certificate of Workers’ Compensation Self-Insurance, OR GSI105.2 – Certificate of Participation in Workers’ Compensation Group
Self-Insurance.
‰
Disability Benefits coverage, for which one of the following is incorporated
into this contract as Appendix E-2:
o CE-200, Affidavit For New York Entities And Any Out-Of-State Entities
With No Employees, That New York State Workers’ Compensation
And/Or Disability Benefits Insurance Coverage Is Not Required; OR
30
o DB-120.1 – Certificate of Disability Benefits Insurance
o DB-155 – Certificate of Disability Benefits Self-Insurance
‰
Appendix G - Notices
‰
Appendix H - Health Insurance Portability and Accountability Act (HIPAA) (if
applicable)
‰
Appendix X – Modification Agreement Form (to accompany modified
appendices for changes in term or consideration on an existing period or for
renewal periods)
SECTION 12: ATTACHMENTS
1.
NYSDOH Regional Office Locations
2.
Letter of Intent to Bid
3.
No Bid Form
4.
Proposal Coversheet
5.
Proposal Checklist
6.
Bid Form
7.
Bidder’s Assurances
8.
Cost Proposal Form
9.
NYS Office of the State Comptroller Vendor Responsibility Questionnaire and
Attestation
10. State Consultant Services Form A, Contractor's Planned Employment From
Contract Start Date through End of Contract Term and State Consultant Services
Form B, Contractor's Annual Employment Report
11. N.Y.S. Taxation and Finance Contractor Certification Form ST-220-TD and N.Y.S.
Taxation and Finance Contractor Certification Form ST-220-CA
12. Appendix A – Standard Clauses for All New York State Contracts
13. Appendix D – General Specifications
14. M/WBE Procurement Forms
31
ATTACHMENT 1
28
DOH Regions and Regional Offices
Capital District Regional Office (CDRO)
1 Fulton Street
Troy, NY 12180-3281
Counties Served: Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene,
Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and
Washington.
Central New York Regional Office (CNYRO)
217 South Salina Street
Syracuse, NY 13202-1380
Counties Served: Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison,
Oneida, Onondaga, Oswego, St. Lawrence, Tioga and Tompkins.
Western Region (WRO)
Western - Buffalo Office
584 Delaware Avenue
Buffalo, NY 14202-1295
Counties Served: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and
Wyoming.
Western - Rochester Office
Triangle Building
335 East Main Street
Rochester, NY 14604-2127
Counties Served: Chemung, Livingston, Monroe, Ontario, Schuyler, Seneca, Steuben, Wayne
and Yates.
Metropolitan Area Regional Office (MARO)
MARO - NYC Office
90 Church Street - 15th Floor
Between Barclay and Vesey Streets
New York, NY 10007-2919
Counties Served: Bronx, Kings, New York, Queens and Richmond.
MARO - Long Island Office
Court House Corporate Center
320 Carlton Avenue
Suite 500 - 5th Floor
Central Islip, NY 11722
Counties Served: Nassau and Suffolk.
MARO - New Rochelle Office
145 Huguenot Street, 6th floor
New Rochelle, NY 10801-5291
Counties Served: Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster and Westchester
ATTACHMENT 2
NOTICE of INTENT to DEVELOP a PROPOSAL in RESPONSE to RFP
This is to notify the New York State Department of Health of this bidder’s intention to
develop/submit a proposal in response to the RFP “State Surveillance Activities for
Hospitals and Diagnostic & Treatment Centers” (RFP Number: #1005101128 ) It is
understood that this Notice of Intent is not binding on either party and simply alerts the
Department of Health of the bidder’s intentions and assures that the bidder will receive
all further correspondence on this RFP
This notice is due to the Department by close of business on August 30, 2010, and
should be mailed, faxed, or emailed to:
Barbara DelCogliano
New York State Department of Health
Division of Certification & Surveillance
433 River Street – 6th Floor
Troy, New York 12180
FAX #: (518) 402-1010
PHONE #: (518) 402-1003
EMAIL: [email protected]
Name of Organization: _________________________________________________
Organization Address: _________________________________________________
City: _______________________ State: __________________ ZIP ____ ______
E- Mail Address: ______________________________________________________
Telephone: ________________________
FAX: _______________________
Authorized Signature: __________________________________________________
Print Name: __________________________________________________________
DATE: ____________________________
ATTACHMENT 3
NEW YORK STATE
DEPARTMENT OF HEALTH
NO-BID FORM
State Surveillance Activities for Hospitals and Diagnostic & Treatment Centers
FAU #1005101128
Bidders choosing not to bid are requested to complete the portion of the
form below:
□
We do not provide the requested services. Please remove our firm from your
mailing list
□
We are unable to bid at this time because:
________________________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
□
Please retain our firm on your mailing list.
________________________________________________________________________________
(Firm Name)
____________________________________
_____________________________________
(Officer Signature)
(Date)
____________________________________
_____________________________________
(Officer Title)
(Telephone)
__________________________________
(e-mail Address)
FAILURE TO RESPOND TO BID INVITATIONS MAY RESULT IN YOUR FIRM BEING REMOVED
FROM OUR MAILING LIST FOR THIS SERVICE.
ATTACHMENT 4
State Surveillance Activities for
Hospitals and Diagnostic & Treatment Centers
FAU# 1005101128
PROPOSAL COVER SHEET
Name of Bidder (Legal name as it would appear on a contract)
Mailing Address (Street address, P.O. Box, City, State, ZIP code)
Federal Employee Identification Number
NYS Charity Registration Number
Person Authorized to act as the contact for this firm in matters regarding this proposal:
Printed Name (First Last)
Title:
Telephone number:
E-mail:
Person authorized to obligate this firm in matters regarding this proposal or the resulting contract:
Printed Name (First Last)
Title:
Telephone number:
E-mail:
(CORPORATIONS) Name/Title of person authorized by the Board of Directors to sign this proposal on
behalf of the Board:
Printed Name (First Last)
Title:
Signature of Bidder or Authorized Representative
Date:
ATTACHMENT 5
PROPOSAL CHECKLIST
State Surveillance Activities for
Hospitals and Diagnostic & Treatment Centers
FAU# 1005101128
This checklist is for the bidder’s use only and should not be included in the proposal.
The checklist is to assist the bidder in preparing their submission; however it is
incumbent on the bidder to read the entire RFP to insure all required documents are
included.
General Requirements
□
The Technical and Cost proposals are packaged in separate and separately
sealed marked envelopes.
□
Signed original plus five (5) paper copies and one (1) CD/DVD of both the
Technical proposal and the Cost proposal.
Technical Proposal Requirements
□
□
□
Proposal Cover sheet (Attachment 4)
Bidder’s Assurances (Attachment 7)
Vitae/Resumes of Key Personnel
Cost Proposal Requirements
□
□
□
□
□
□
□
Bid Form (Attachment 6)
Cost Proposal Form (Attachment 8)
Proof of incorporation and financial viability
Vendor Responsibility Attestation (Attachment 9)
State Consultant Forms (Attachment 10)
NYS Tax and Finance Forms ST-220-TD and ST-220-CA (Attachment 11)
MWBE forms (Attachment 14)
ATTACHMENT 6
NEW YORK STATE
DEPARTMENT OF HEALTH
BID FORM
State Surveillance Activities for
Hospitals and Diagnostic & Treatment Centers
FAU# 1005101128
Bidder Name:
Bidder Address:
Bidder Fed ID No:
A. _________________________________bids a total price of $________________
(Name of Offerer/Bidder)
B. Affirmations & Disclosures related to State Finance Law §§ 139-j & 139-k:
Offerer/Bidder affirms that it understands and agrees to comply with the procedures
of the Department of Health relative to permissible contacts (provided below) as
required by State Finance Law §139-j (3) and §139-j (6) (b).
Pursuant to State Finance Law §§139-j and 139-k, this Invitation for Bid or Request for Proposal
includes and imposes certain restrictions on communications between the Department of Health
(DOH) and an Offerer during the procurement process. An Offerer/bidder is restricted from making
contacts from the earliest notice of intent to solicit bids/proposals through final award and approval of
the Procurement Contract by the DOH and, if applicable, Office of the State Comptroller (“restricted
period”) to other than designated staff unless it is a contact that is included among certain statutory
exceptions set forth in State Finance Law §139-j(3)(a). Designated staff, as of the date hereof, is/are
identified on the first page of this Invitation for Bid, Request for Proposal, or other solicitation
document. DOH employees are also required to obtain certain information when contacted during the
restricted period and make a determination of the responsibility of the Offerer/bidder pursuant to
these two statutes. Certain findings of non-responsibility can result in rejection for contract award and
in the event of two findings within a 4 year period, the Offerer/bidder is debarred from obtaining
governmental Procurement Contracts. Further information about these requirements can be found on
the
Office
of
General
Services
Website
at:
http://www.ogs.state.ny.us/aboutOgs/regulations/defaultAdvisoryCouncil.html
1. Has any Governmental Entity made a finding of non-responsibility regarding the
individual or entity seeking to enter into the Procurement Contract in the previous
four years? (Please circle):
No
Yes
If yes, please answer the next questions:
1a. Was the basis for the finding of non-responsibility due to a violation of State
Finance Law §139-j (Please circle):
No
Yes
1b. Was the basis for the finding of non-responsibility due to the intentional
provision of false or incomplete information to a Governmental Entity?
(Please circle):
No
Yes
1c. If you answered yes to any of the above questions, please provide details
regarding the finding of non-responsibility below.
Governmental Entity:__________________________________________
Date of Finding of Non-responsibility: ___________________________
Basis of Finding of Non-Responsibility:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______
(Add additional pages as necessary)
2a. Has any Governmental Entity or other governmental agency terminated or
withheld a Procurement Contract with the above-named individual or entity
due to the intentional provision of false or incomplete information? (Please
circle):
No
Yes
2b. If yes, please provide details below.
Governmental Entity: _______________________________________
Date of Termination or Withholding of Contract: _________________
Basis of Termination or Withholding:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______
(Add additional pages as necessary)
C. Offerer/Bidder certifies that all information provided to the Department of Health with
respect to State Finance Law §139-k is complete, true and accurate.
D. Offerer/Bidder agrees to provide the following documentation either with their
submitted bid/proposal or upon award as indicated below:
With Bid
Upon Award
1. A completed N.Y.S Taxation and Finance Contractor
Certification Form ST-220.
2. A completed N.Y.S. Office of the State Comptroller Vendor
Responsibility Questionnaire (for procurements greater than
or equal to $100,000)
3. A completed State Consultant Services Form A, Contractor's
Planned Employment From Contract Start Date through End of
Contract Term
________________________________________
___________________________________
(Officer Signature)
(Date)
_________________________________________
___________________________________
(Officer Title)
(Telephone)
____________________________________
(e-mail Address)
ATTACHMENT 7
BIDDER’S ASSURANCES
State Surveillance Activities for
Hospitals and Diagnostic & Treatment Centers
FAU# 1005101128
The Bidder’s Assurances form MUST be signed in ink by an official authorized to bind the
organization to the provisions of the RFP and Proposal. Proposals which do not include this
signed form will be considered non-responsive, resulting in rejection of the Proposal.
•
The bidder is a public or private organization, company, partnership, or corporation that is
authorized to operate in New York State.
•
The bidder and its subsidiaries are not providers of health care services, a health care
facility accrediting body or any organization or trade association whose primary business
includes representing any Article 28 licensed provider.
•
The bidder accepts the terms and conditions as stated in the RFP.
•
The bid is valid for a period of three hundred sixty-five (365) calendar days from the date of
submission of the proposal.
•
The bidder agrees to be responsible to the Department for performance of all work
specified in the RFP, including work assigned to subcontractors.
•
The bidder assures that the detailed work plan and schedule of deliverables set forth by the
organization as its Technical Proposal will fulfill all statewide requirements as described in
the RFP and will provide for the dedicated qualified staff, expertise and capacity to fulfill
contract deliverables.
•
The bidder assures that the organization and its employees, subcontractors, consultants,
volunteers, and subsidiaries, are not and will not be directly or indirectly involved with any
provider or parties whose activities would represent a conflict of interest with respect to
conducting the duties and responsibilities outlined in this RFP.
•
The bidder assures the organization and its employees, subcontractors, consultants and
volunteers will implement and maintain policies and procedures to assure the confidentiality
of personally identifiable data and information or records pertaining to patient care including
compliance with all pertinent Health Insurance Portability and Accountability Act (HIPAA)
requirements and Article 27F of the Public Health Law.
•
The bidder assures its ability to secure an indemnity to protect the organization and, in turn,
the State against any loss of claim incurred as a result of carrying out the duties and
responsibilities of this program.
•
The bidder assures that no funds were paid or will be paid, by or on behalf of the bidder, to
any person for the purpose of influencing or attempting to influence any officer or employee
of the federal or state government with regard to obtaining a contract.
________________________________
Signature of Authorized Official
________________________________
Printed Name of Authorized Official
________________
Date
ATTACHMENT 8
State Surveillance Activities for Hospitals and Diagnostic & Treatment Centers
FAU# 1005101128
COST PROPOSAL FORM
SERVICE UNITS
Receipt, Review, Referral
DTC Surveys
ESTIMATED
ANNUAL
VOLUME
(a)
YEAR 1
UNIT BID
PRICE
(b)
YEAR 2
UNIT BID
PRICE
(c)
YEAR 3
UNIT BID
PRICE
(d)
YEAR 4
UNIT BID
PRICE
(e)
YEAR 5
UNIT BID
PRICE
(f)
4,100
45
On-site Investigations
164
Off-site Investigations
458
RCA Reviews
605
TOTAL BID AMOUNT**
**The total bid is each of the five year’s unit bids multiplied by the corresponding estimated annual
volumes, summed.
BID
AMOUNT
ATTACHMENT 9
Vendor Responsibility Attestation
To comply with the Vendor Responsibility Requirements outlined in Section E, Administrative,
8. Vendor Responsibility Questionnaire, I hereby certify:
Choose one:
An on-line Vender Responsibility Questionnaire has been updated or created at
OSC's website: https://portal.osc.state.ny.us within the last six months.
A hard copy Vendor Responsibility Questionnaire is included with this proposal/bid
and is dated within the last six months.
A Vendor Responsibility Questionnaire is not required due to an exempt status.
Exemptions include governmental entities, public authorities, public colleges and
universities, public benefit corporations, and Indian Nations.
Signature of Organization Official:
Print/type Name:
Title:
Organization:
Date Signed:
ATTACHMENT 10
State Consultant Services
OSC Use Only
Reporting Code:
Category Code:
Date Contract Approved:
FORM A
Contractor’s Planned Employment
From Contract Start Date through End of Contract Term
New York State Department of Health
Contractor Name:
Agency Code 12000
Contract Number:
Contract Start Date:
Contract End Date:
/
/
Employment Category
Number of
Employees
Totals this page:
Grand Total:
/
Number of Hours to
be Worked
0
0
/
Amount Payable
Under the Contract
0
0
Name of person who prepared this report:
Title:
Preparer’s signature:
Date Prepared: / /
Phone #:
Page
of
(use additional pages if necessary)
$ 0.00
$ 0.00
State Consultant Services
OSC Use Only
FORM B
Reporting Code:
Category Code:
Contractor’s Annual Employment Report
Report Period: April 1, ____ to March 31, ____
New York State Department of Health
Contract Number:
Contract Start Date: /
/
Contractor Name:
Contractor Address:
Agency Code 12000
Contract End Date:
/
/
Description of Services Being Provided:
Scope of Contract (Chose one that best fits):
Analysis
Evaluation
Training
Data Processing
Other IT Consulting
Engineering
Surveying
Environmental Services
Mental Health Services
Accounting
Paralegal
Legal
Employment Category
Number of
Employees
Totals this page:
Grand Total:
Name of person who prepared this report:
Title:
Preparer’s signature:
Date Prepared: / /
Research
Computer Programming
Architect Services
Health Services
Auditing
Other Consulting
Number of Hours to
be Worked
0
0
Amount Payable
Under the Contract
0
0
Phone #:
Page
of
(use additional pages if necessary)
$ 0.00
$ 0.00
Instructions
State Consultant Services
Form A: Contractor’s Planned Employment
And
Form B: Contractor’s Annual Employment Report
Form A:
This report must be completed before work begins on a contract. Typically it is
completed as a part of the original bid proposal. The report is submitted only to the
soliciting agency who will in turn submit the report to the NYS Office of the State
Comptroller.
Form B:
This report must be completed annually for the period April 1 through March 31. The
report must be submitted by May 15th of each year to the following three addresses:
1.
The designated payment office (DPO) outlined in the consulting contract.
2.
NYS Office of the State Comptroller
Bureau of Contracts
110 State Street, 11th Floor
Albany, NY 12236
Attn: Consultant Reporting
or via fax to –
(518) 474-8030 or (518) 473-8808
3.
NYS Department of Civil Service
Alfred E. Smith Office Building
Albany, NY 12239
Attn: Consultant Reporting
Completing the Reports:
Scope of Contract (Form B only): a general classification of the single category that best fits the
predominate nature of the services provided under the contract.
Employment Category: the specific occupation(s), as listed in the O*NET occupational classification
system, which best describe the employees providing services under the contract. Access the O*NET
database, which is available through the US Department of Labor’s Employment and Training
Administration, on-line at online.onetcenter.org to find a list of occupations.)
Number of Employees: the total number of employees in the employment category employed to
provide services under the contract during the Report Period, including part time employees and
employees of subcontractors.
Number of hours (to be) worked: for Form A, the total number of hours to be worked, and for Form B,
the total number of hours worked during the Report Period by the employees in the employment
category.
Amount Payable under the Contract: the total amount paid or payable by the State to the State
contractor under the contract, for work by the employees in the employment category, for services
provided during the Report Period.
ATTACHMENT 11
NYS Taxation and Finance Form ST-220-TD
This form may be accessed electronically at:
http://www.tax.state.ny.us/pdf/2007/fillin/st/st220td_507_fill_in.pdf
NYS Taxation and Finance Form ST-220-CA
This form may be accessed electronically at:
http://www.tax.state.ny.us/pdf/2006/fillin/st/st220ca_606_fill_in.pdf
ATTACHMENT 12
APPENDIX A - STANDARD CLAUSES FOR NYS
CONTRACTS
The parties to the attached contract, license, lease,
amendment or other agreement of any kind (hereinafter, "the
contract" or "this contract") agree to be bound by the following
clauses which are hereby made a part of the contract (the word
"Contractor" herein refers to any party other than the State,
whether a contractor, licenser, licensee, lessor, lessee or any other
party):
1. EXECUTORY CLAUSE. In accordance with Section 41 of
the State Finance Law, the State shall have no liability under this
contract to the Contractor or to anyone else beyond funds
appropriated and available for this contract.
2. NON-ASSIGNMENT CLAUSE. In accordance with Section
138 of the State Finance Law, this contract may not be assigned by
the Contractor or its right, title or interest therein assigned,
transferred, conveyed, sublet or otherwise disposed of without the
previous consent, in writing, of the State and any attempts to
assign the contract without the State's written consent are null and
void. The Contractor may, however, assign its right to receive
payment without the State's prior written consent unless this
contract concerns Certificates of Participation pursuant to Article
5-A of the State Finance Law.
3. COMPTROLLER'S APPROVAL. In accordance with
Section 112 of the State Finance Law (or, if this contract is with
the State University or City University of New York, Section 355
or Section 6218 of the Education Law), if this contract exceeds
$50,000 (or the minimum thresholds agreed to by the Office of the
State Comptroller for certain S.U.N.Y. and C.U.N.Y. contracts), or
if this is an amendment for any amount to a contract which, as so
amended, exceeds said statutory amount, or if, by this contract, the
State agrees to give something other than money when the value or
reasonably estimated value of such consideration exceeds $10,000,
it shall not be valid, effective or binding upon the State until it has
been approved by the State Comptroller and filed in his office.
Comptroller's approval of contracts let by the Office of General
Services is required when such contracts exceed $85,000 (State
Finance Law Section 163.6.a).
4. WORKERS' COMPENSATION BENEFITS. In accordance
with Section 142 of the State Finance Law, this contract shall be
void and of no force and effect unless the Contractor shall provide
and maintain coverage during the life of this contract for the
benefit of such employees as are required to be covered by the
provisions of the Workers' Compensation Law.
5. NON-DISCRIMINATION REQUIREMENTS. To the extent
required by Article 15 of the Executive Law (also known as the
Human Rights Law) and all other State and Federal statutory and
constitutional non-discrimination provisions, the Contractor will
not discriminate against any employee or applicant for
employment because of race, creed, color, sex, national origin,
sexual orientation, age, disability, genetic predisposition or carrier
status, or marital status. Furthermore, in accordance with Section
220-e of the Labor Law, if this is a contract for the construction,
alteration or repair of any public building or public work or for the
manufacture, sale or distribution of materials, equipment or
supplies, and to the extent that this contract shall be performed
within the State of New York, Contractor agrees that neither it nor
its subcontractors shall, by reason of race, creed, color, disability,
sex, or national origin: (a) discriminate in hiring against any New
York State citizen who is qualified and available to perform the
work; or (b) discriminate against or intimidate any employee hired
for the performance of work under this contract. If this is a
building service contract as defined in Section 230 of the Labor
Law, then, in accordance with Section 239 thereof, Contractor
agrees that neither it nor its subcontractors shall by reason of race,
creed, color, national origin, age, sex or disability: (a) discriminate
in hiring against any New York State citizen who is qualified and
available to perform the work; or (b) discriminate against or
intimidate any employee hired for the performance of work under
this contract. Contractor is subject to fines of $50.00 per person per
day for any violation of Section 220-e or Section 239 as well as
possible termination of this contract and forfeiture of all moneys
due hereunder for a second or subsequent violation.
6. WAGE AND HOURS PROVISIONS. If this is a public work
contract covered by Article 8 of the Labor Law or a building
service contract covered by Article 9 thereof, neither Contractor's
employees nor the employees of its subcontractors may be required
or permitted to work more than the number of hours or days stated
in said statutes, except as otherwise provided in the Labor Law and
as set forth in prevailing wage and supplement schedules issued by
the State Labor Department. Furthermore, Contractor and its
subcontractors must pay at least the prevailing wage rate and pay
or provide the prevailing supplements, including the premium rates
for overtime pay, as determined by the State Labor Department in
accordance with the Labor Law.
7. NON-COLLUSIVE BIDDING CERTIFICATION. In
accordance with Section 139-d of the State Finance Law, if this
contract was awarded based upon the submission of bids,
Contractor affirms, under penalty of perjury, that its bid was
arrived at independently and without collusion aimed at restricting
competition. Contractor further affirms that, at the time Contractor
submitted its bid, an authorized and responsible person executed
and delivered to the State a non-collusive bidding certification on
Contractor's behalf.
8.
INTERNATIONAL BOYCOTT PROHIBITION.
In
accordance with Section 220-f of the Labor Law and Section 139-h
of the State Finance Law, if this contract exceeds $5,000, the
Contractor agrees, as a material condition of the contract, that
neither the Contractor nor any substantially owned or affiliated
person, firm, partnership or corporation has participated, is
participating, or shall participate in an international boycott in
violation of the federal Export Administration Act of 1979 (50
USC App. Sections 2401 et seq.) or regulations thereunder. If such
Contractor, or any of the aforesaid affiliates of Contractor, is
convicted or is otherwise found to have violated said laws or
regulations upon the final determination of the United States
Commerce Department or any other appropriate agency of the
United States subsequent to the contract's execution, such contract,
amendment or modification thereto shall be rendered forfeit and
void. The Contractor shall so notify the State Comptroller within
five (5) business days of such conviction, determination or
disposition of appeal (2NYCRR 105.4).
9. SET-OFF RIGHTS. The State shall have all of its common
law, equitable and statutory rights of set-off. These rights shall
include, but not be limited to, the State's option to withhold for the
purposes of setoff any moneys due to the Contractor under this
contract up to any amounts due and owing to the State with regard
to this contract, any other contract with any State department or
agency, including any contract for a term commencing prior to the
term of this contract, plus any amounts due and owing to the State
for any other reason including, without limitation, tax
delinquencies, fee delinquencies or monetary penalties relative
thereto. The State shall exercise its set-off rights in accordance
with normal State practices including, in cases of set-off pursuant
to an audit, the finalization of such audit by the State agency, its
representatives, or the State Comptroller.
10. RECORDS. The Contractor shall establish and maintain
complete and accurate books, records, documents, accounts and
other evidence directly pertinent to performance under this contract
(hereinafter, collectively, "the Records"). The Records must be
kept for the balance of the calendar year in which they were made
and for six (6) additional years thereafter. The State Comptroller,
the Attorney General and any other person or entity authorized to
conduct an examination, as well as the agency or agencies
involved in this contract, shall have access to the Records during
normal business hours at an office of the Contractor
within the State of New York or, if no such office is available, at a
mutually agreeable and reasonable venue within the State, for the
term specified above for the purposes of inspection, auditing and
copying. The State shall take reasonable steps to protect from
public disclosure any of the Records which are exempt from
disclosure under Section 87 of the Public Officers Law (the
"Statute") provided that: (i) the Contractor shall timely inform an
appropriate State official, in writing, that said records should not
be disclosed; and (ii) said records shall be sufficiently identified;
and (iii) designation of said records as exempt under the Statute is
reasonable. Nothing contained herein shall diminish, or in any
way adversely affect, the State's right to discovery in any pending
or future litigation.
11. IDENTIFYING INFORMATION AND PRIVACY
NOTIFICATION.
(a)
FEDERAL
EMPLOYER
IDENTIFICATION NUMBER and/or FEDERAL SOCIAL
SECURITY NUMBER. All invoices or New York State standard
vouchers submitted for payment for the sale of goods or services or
the lease of real or personal property to a New York State agency
must include the payee's identification number, i.e., the seller's or
lessor's identification number. The number is either the payee's
Federal employer identification number or Federal social security
number, or both such numbers when the payee has both such
numbers. Failure to include this number or numbers may delay
payment. Where the payee does not have such number or
numbers, the payee, on its invoice or New York State standard
voucher, must give the reason or reasons why the payee does not
have such number or numbers.
(b) PRIVACY NOTIFICATION. (1) The authority to request the
above personal information from a seller of goods or services or a
lessor of real or personal property, and the authority to maintain
such information, is found in Section 5 of the State Tax Law.
Disclosure of this information by the seller or lessor to the State is
mandatory. The principal purpose for which the information is
collected is to enable the State to identify individuals, businesses
and others who have been delinquent in filing tax returns or may
have understated their tax liabilities and to generally identify
persons affected by the taxes administered by the Commissioner of
Taxation and Finance. The information will be used for tax
administration purposes and for any other purpose authorized by
law.
(2) The personal information is requested by the purchasing unit
of the agency contracting to purchase the goods or services or lease
the real or personal property covered by this contract or lease. The
information is maintained in New York State's Central Accounting
System by the Director of Accounting Operations, Office of the
State Comptroller, 110 State Street, Albany, New York 12236.
12. EQUAL EMPLOYMENT OPPORTUNITIES FOR
MINORITIES AND WOMEN. In accordance with Section 312
of the Executive Law, if this contract is: (i) a written agreement
or purchase order instrument, providing for a total expenditure in
excess of $25,000.00, whereby a contracting agency is committed
to expend or does expend funds in return for labor, services,
supplies, equipment, materials or any combination of the
foregoing, to be performed for, or rendered or furnished to the
contracting agency; or (ii) a written agreement in excess of
$100,000.00 whereby a contracting agency is committed to expend
or does expend funds for the acquisition, construction, demolition,
replacement, major repair or renovation of real property and
improvements thereon; or (iii) a written agreement in excess of
$100,000.00 whereby the owner of a State assisted housing project
is committed to expend or does expend funds for the acquisition,
construction, demolition, replacement, major repair or renovation
of real property and improvements thereon for such project, then:
(a) The Contractor will not discriminate against employees or
applicants for employment because of race, creed, color, national
origin, sex, age, disability or marital status, and will undertake or
continue existing programs of affirmative action to ensure that
minority group members and women are afforded equal
employment opportunities without discrimination. Affirmative
action shall mean recruitment, employment, job assignment,
promotion, upgradings, demotion, transfer, layoff, or termination
and rates of pay or other forms of compensation;
(b) at the request of the contracting agency, the Contractor shall
request each employment agency, labor union, or authorized
representative of workers with which it has a collective bargaining
or other agreement or understanding, to furnish a written statement
that such employment agency, labor union or representative will
not discriminate on the basis of race, creed, color, national origin,
sex, age, disability or marital status and that such union or
representative will affirmatively cooperate in the implementation
of the contractor's obligations herein; and
(c) the Contractor shall state, in all solicitations or advertisements
for employees, that, in the performance of the State contract, all
qualified applicants will be afforded equal employment
opportunities without discrimination because of race, creed, color,
national origin, sex, age, disability or marital status.
Contractor will include the provisions of "a", "b", and "c" above, in
every subcontract over $25,000.00 for the construction,
demolition, replacement, major repair, renovation, planning or
design of real property and improvements thereon (the "Work")
except where the Work is for the beneficial use of the Contractor.
Section 312 does not apply to: (i) work, goods or services
unrelated to this contract; or (ii) employment outside New York
State; or (iii) banking services, insurance policies or the sale of
securities. The State shall consider compliance by a contractor or
subcontractor with the requirements of any federal law concerning
equal employment opportunity which effectuates the purpose of
this section. The contracting agency shall determine whether the
imposition of the requirements of the provisions hereof duplicate
or conflict with any such federal law and if such duplication or
conflict exists, the contracting agency shall waive the applicability
of Section 312 to the extent of such duplication or conflict.
Contractor will comply with all duly promulgated and lawful rules
and regulations of the Governor's Office of Minority and Women's
Business Development pertaining hereto.
13. CONFLICTING TERMS. In the event of a conflict between
the terms of the contract (including any and all attachments thereto
and amendments thereof) and the terms of this Appendix A, the
terms of this Appendix A shall control.
14. GOVERNING LAW. This contract shall be governed by the
laws of the State of New York except where the Federal
supremacy clause requires otherwise.
15. LATE PAYMENT. Timeliness of payment and any interest
to be paid to Contractor for late payment shall be governed by
Article 11-A of the State Finance Law to the extent required by
law.
16. NO ARBITRATION. Disputes involving this contract,
including the breach or alleged breach thereof, may not be
submitted to binding arbitration (except where statutorily
authorized), but must, instead, be heard in a court of competent
jurisdiction of the State of New York.
17. SERVICE OF PROCESS. In addition to the methods of
service allowed by the State Civil Practice Law & Rules
("CPLR"), Contractor hereby consents to service of process upon
it by registered or certified mail, return receipt requested. Service
hereunder shall be complete upon Contractor's actual receipt of
process or upon the State's receipt of the return thereof by the
United States Postal Service as refused or undeliverable.
Contractor must promptly notify the State, in writing, of each and
every change of address to which service of process can be made.
Service by the State to the last known address shall be sufficient.
Contractor will have thirty (30) calendar days after service
hereunder is complete in which to respond.
18. PROHIBITION ON PURCHASE OF TROPICAL
HARDWOODS. The Contractor certifies and warrants that all
wood products to be used under this contract award will be in
accordance with, but not limited to, the specifications and
provisions of State Finance Law §165. (Use of Tropical
Hardwoods) which prohibits purchase and use of tropical
hardwoods, unless specifically exempted, by the State or any
governmental agency or political subdivision or public benefit
corporation. Qualification for an exemption under this law will be
the responsibility of the contractor to establish to meet with the
approval of the State.
In addition, when any portion of this contract involving the use of
woods, whether supply or installation, is to be performed by any
subcontractor, the prime Contractor will indicate and certify in the
submitted bid proposal that the subcontractor has been informed
and is in compliance with specifications and provisions regarding
use of tropical hardwoods as detailed in §165 State Finance Law.
Any such use must meet with the approval of the State; otherwise,
the bid may not be considered responsive. Under bidder
certifications, proof of qualification for exemption will be the
responsibility of the Contractor to meet with the approval of the
State.
19. MACBRIDE FAIR EMPLOYMENT PRINCIPLES. In
accordance with the MacBride Fair Employment Principles
(Chapter 807 of the Laws of 1992), the Contractor hereby
stipulates that the Contractor either (a) has no business operations
in Northern Ireland, or (b) shall take lawful steps in good faith to
conduct any business operations in Northern Ireland in accordance
with the MacBride Fair Employment Principles (as described in
Section 165 of the New York State Finance Law), and shall permit
independent monitoring of compliance with such principles.
20. OMNIBUS PROCUREMENT ACT OF 1992. It is the
policy of New York State to maximize opportunities for the
participation of New York State business enterprises, including
minority and women-owned business enterprises as bidders,
subcontractors and suppliers on its procurement contracts.
Information on the availability of New York State subcontractors
and suppliers is available from:
NYS Department of Economic Development
Division for Small Business
30 South Pearl St -- 7th Floor
Albany, New York 12245
Telephone: 518-292-5220
Fax: 518-292-5884
http://www.empire.state.ny.us
A directory of certified minority and women-owned business
enterprises is available from:
NYS Department of Economic Development
Division of Minority and Women's Business Development
30 South Pearl St -- 2nd Floor
Albany, New York 12245
Telephone: 518-292-5250
Fax: 518-292-5803
http://www.empire.state.ny.us
The Omnibus Procurement Act of 1992 requires that by signing
this bid proposal or contract, as applicable, Contractors certify that
whenever the total bid amount is greater than $1 million:
(a) The Contractor has made reasonable efforts to encourage the
participation of New York State Business Enterprises as suppliers
and subcontractors, including certified minority and women-owned
business enterprises, on this project, and has retained the
documentation of these efforts to be provided upon request to the
State;
(b) The Contractor has complied with the Federal Equal
Opportunity Act of 1972 (P.L. 92-261), as amended;
(c) The Contractor agrees to make reasonable efforts to provide
notification to New York State residents of employment
opportunities on this project through listing any such positions
with the Job Service Division of the New York State Department
of Labor, or providing such notification in such manner as is
consistent with existing collective bargaining contracts or
agreements. The Contractor agrees to document these efforts and
to provide said documentation to the State upon request; and
(d The Contractor acknowledges notice that the State may seek to
obtain offset credits from foreign countries as a result of this
contract and agrees to cooperate with the State in these efforts.
21.
RECIPROCITY AND SANCTIONS PROVISIONS.
Bidders are hereby notified that if their principal place of business
is located in a country, nation, province, state or political
subdivision that penalizes New York State vendors, and if the
goods or services they offer will be substantially produced or
performed outside New York State, the Omnibus Procurement Act
1994 and 2000 amendments (Chapter 684 and Chapter 383,
respectively) require that they be denied contracts which they
would otherwise obtain. NOTE: As of May 15, 2002, the list of
discriminatory jurisdictions subject to this provision includes the
states of South Carolina, Alaska, West Virginia, Wyoming,
Louisiana and Hawaii. Contact NYS Department of Economic
Development for a current list of jurisdictions subject to this
provision.
22. PURCHASES OF APPAREL. In accordance with State
Finance Law 162 (4-a), the State shall not purchase any apparel
from any vendor unable or unwilling to certify that: (i) such
apparel was manufactured in compliance with all applicable labor
and occupational safety laws, including, but not limited to, child
labor laws, wage and hours laws and workplace safety laws, and
(ii) vendor will supply, with its bid (or, if not a bid situation, prior
to or at the time of signing a contract with the State), if known, the
names and addresses of each subcontractor and a list of all
manufacturing plants to be utilized by the bidder.
ATTACHMENT 13
APPENDIX D
GENERAL SPECIFICATIONS
A.
By signing the "Bid Form" each bidder attests to its express authority to sign on behalf of this
company or other entity and acknowledges and accepts that:
All specifications, general and specific appendices, including Appendix-A, the Standard
Clauses for all New York State contracts, and all schedules and forms contained herein will
become part of any contract entered, resulting from the Request for Proposal. Anything which
is not expressly set forth in the specification, appendices and forms and resultant contract,
but which is reasonable to be implied, shall be furnished and provided in the same manner as
if specifically expressed.
B.
The work shall be commenced and shall be actually undertaken within such time as the Department
of Health may direct by notice, whether by mail, telegram, or other writing, whereupon the
undersigned will give continuous attention to the work as directed, to the end and with the intent
that the work shall be completed within such reasonable time or times, as the case may be, as the
Department may prescribe.
C.
The Department reserves the right to stop the work covered by this proposal and the contract at
any time that the Department deems the successful bidder to be unable or incapable of performing
the work to the satisfaction of the Department and in the event of such cessation of work, the
Department shall have the right to arrange for the completion of the work in such manner as the
Department may deem advisable and if the cost thereof exceeds the amount of the bid, the
successful bidder and its surety be liable to the State of New York for any excess cost on account
thereof.
D.
Each bidder is under an affirmative duty to be informed by personal examination of the
specifications and location of the proposed work and by such other means as it may select, of
character, quality, and extent of work to be performed and the conditions under which the contract
is to be executed.
E.
The Department of Health will make no allowances or concession to a bidder for any alleged
misunderstanding or deception because of quantity, quality, character, location or other conditions.
F.
The bid price is to cover the cost of furnishing all of the said services, materials, equipment, and
labor to the satisfaction of the Department of Health and the performance of all work set forth in
said specifications.
G.
The successful bidder will be required to complete the entire work, or any part thereof as the case
may be, to the satisfaction of the Department of Health in strict accordance with the specifications
and pursuant to a contract therefore.
H.
Contractor will possess, at no cost to the State, all qualifications, licenses and permits to engage in
the required business as may be required within the jurisdiction where the work specified is to be
performed. Workers to be employed in the performance of this contract will possess the
qualifications, training, licenses and permits as may be required within such jurisdiction.
I.
Non-Collusive Bidding
By submission of this proposal, each bidder and each person signing on behalf of any bidder
certifies, and in the case of a joint bid each party thereto certifies as to its own organization, under
penalty of perjury, that to the best of their knowledge and belief:
a. The prices of this bid have been arrived at independently without collusion,
consultation, communication, or agreement, for the purpose of restricting competition,
as to any matter relating to such prices with any other bidder or with any competitor;
b. Unless otherwise required by law, the prices which have been quoted in this bid have
not been knowingly disclosed by the bidder and will not knowingly be disclosed by the
bidder prior to opening, directly or indirectly to any other person, partnership or
corporation to submit or not to submit a bid for the purpose of restricting competition;
c.
No attempt has been made or will be made by the bidder to induce any other person,
partnership or corporation to submit or not to submit a bid for the purpose of restricting
competition.
NOTE: Chapter 675 of the Laws of New York for 1966 provides that every bid made to the state or
any public department, agency or official thereof, where competitive bidding is required by statute,
rule or regulation, for work or services performed or to be performed or goods sold or to be sold,
shall contain the foregoing statement subscribed by the bidder and affirmed by such bidder as true
under penalties of perjury.
A bid shall not be considered for award nor shall any award be made where (a), (b) and (c) above
have not been complied with; provided however, that if in any case the bidder cannot make the
foregoing certification, the bidder shall so state and shall furnish with the bid a signed statement
which sets forth in detail the reasons therefore. Where (a), (b) and (c) above have not been
complied with, the bid shall not be considered for award nor shall any award be made unless the
head of the purchasing unit of the state, public department or agency to which the bid is made or its
designee, determines that such disclosure was not made for the purpose of restricting competition.
The fact that a bidder has published price lists, rates, or tariffs covering items being procured, has
informed prospective customers of proposed or pending publication of new or revised price lists for
such items, or has sold the same items to other customers at the same price being bid, does not
constitute, without more, a disclosure within the meaning of the above quoted certification.
Any bid made to the State or any public department, agency or official thereof by a corporate bidder
for work or services performed or to be performed or goods, sold or to be sold, where competitive
bidding is required by statute, rule or regulation and where such bid contains the certification set
forth above shall be deemed to have been authorized by the board of directors of the bidder, and
such authorization shall be deemed to include the signing and submission of the bid and the
inclusion therein of the certificate as to non-collusion as the act and deed of the corporation.
J.
A bidder may be disqualified from receiving awards if such bidder or any subsidiary, affiliate,
partner, officer, agent or principal thereof, or anyone in its or its employ, has previously failed to
perform satisfactorily in connection with public bidding or contracts.
K.
The Department reserves the right to make awards within ninety (90) days after the date of the bid
opening, during which period bids shall not be withdrawn unless the bidder distinctly states in the
bid that acceptance thereof must be made within a shorter specified time.
L.
Work for Hire Contract
Any contract entered into resultant from this request for proposal will be considered a "Work for Hire
Contract." The Department will be the sole owner of all source code and any software which is
developed or included in the application software provided to the Department as a part of this
contract.
M.
Technology Purchases Notification -- The following provisions apply if this Request for Proposal
(RFP) seeks proposals for "Technology"
1. For the purposes of this policy, "technology" applies to all services and commodities,
voice/data/video and/or any related requirement, major software acquisitions, systems
modifications or upgrades, etc., that result in a technical method of achieving a practical
purpose or in improvements of productivity. The purchase can be as simple as an order for new
or replacement personal computers, or for a consultant to design a new system, or as complex
as a major systems improvement or innovation that changes how an agency conducts its
business practices.
2. If this RFP results in procurement of software over $20,000, or of other technology over
$50,000, or where the department determines that the potential exists for coordinating
purchases among State agencies and/or the purchase may be of interest to one or more other
State agencies, PRIOR TO AWARD SELECTION, this RFP and all responses thereto are
subject to review by the New York State Office for Technology.
3. Any contract entered into pursuant to an award of this RFP shall contain a provision which
extends the terms and conditions of such contract to any other State agency in New York.
Incorporation of this RFP into the resulting contract also incorporates this provision in the
contract.
4. The responses to this RFP must include a solution to effectively handle the turn of the century
issues related to the change from the year 1999 to 2000.
N.
YEAR 2000 WARRANTY
1. Definitions
For purposes of this warranty, the following definitions shall apply:
a. Product shall include, without limitation: any piece or component of equipment, hardware,
firmware, middleware, custom or commercial software, or internal components or
subroutines therein which perform any date/time data recognition function, calculation,
comparing or sequencing. Where services are being furnished, e.g. consulting, systems
integration, code or data conversion or data entry, the term Product shall include resulting
deliverables.
b. Vendor’s Product shall include all Product delivered under this Agreement by Vendor other
than Third Party Product.
c.
Third Party Product shall include products manufactured or developed by a corporate entity
independent from Vendor and provided by Vendor on a non-exclusive licensing or other
distribution Agreement with the third party manufacturer. Third Party Product does not
include product where Vendor is: a) corporate subsidiary or affiliate of the third party
manufacturer/developer; and/or b) the exclusive re-seller or distributor of product
manufactured or developed by said corporate entity.
2. Warranty Disclosure
At the time of bid, Product order or Product quote, Vendor is required to disclose the following
information in writing to Authorized User:
a. For Vendor Product and for Products (including, but not limited to, Vendor and/or Third
Party Products and/or Authorized User's Installed Product) which have been specified to
perform as a system: Compliance or non-compliance of the Products individually or as a
system with the Warranty Statement set forth below; and
b. For Third Party Product Not Specified as Part of a System: Third Party Manufacturer's
statement of compliance or non-compliance of any Third Party Product being delivered with
Third Party Manufacturer/Developer's Year 2000 warranty. If such Third Party Product is
represented by Third Party Manufacturer/Developer as compliant with Third Party
Manufacturer/Developer's Year 2000 Warranty, Vendor shall pass through said third party
warranty from the third party manufacturer to the Authorized User but shall not be liable for
the testing or verification of Third Party's compliance statement. .
An absence or failure to furnish the required written warranty disclosure shall be deemed a
statement of compliance of the product(s) or system(s) in question with the year 2000 warranty
statement set forth below.
3. Warranty Statement
Year 2000 warranty compliance shall be defined in accordance with the following warranty
statement:
Vendor warrants that Product(s) furnished pursuant to this Agreement shall, when used in
accordance with the Product documentation, be able to accurately process date/time data
(including, but not limited to, calculating, comparing, and sequencing) from, into, and between
the twentieth and twenty-first centuries, and the years 1999 and 2000, including leap year
calculations. Where a purchase requires that specific Products must perform as a package or
system, this warranty shall apply to the Products as a system.
In the event of any breach of this warranty, Vendor shall restore the Product to the same level
of performance as warranted herein, or repair or replace the Product with conforming Product
so as to minimize interruption to Authorized User's ongoing business processes, time being of
the essence, at Vendor's sole cost and expense. This warranty does not extend to correction of
Authorized User's errors in data entry or data conversion.
This warranty shall survive beyond termination or expiration of the Agreement.
Nothing in this warranty shall be construed to limit any rights or remedies otherwise available
under this Agreement.
O.
No Subcontracting
Subcontracting by the contractor shall not be permitted except by prior written approval and
knowledge of the Department of Health.
P.
Superintendence by Contractor
The Contractor shall have a representative to provide supervision of the work which Contractor
employees are performing to ensure complete and satisfactory performance with the terms of the
Contract. This representative shall also be authorized to receive and put into effect promptly all
orders, directions and instructions from the Department of Health. A confirmation in writing of such
orders or directions will be given by the Department when so requested from the Contractor.
Q.
Sufficiency of Personnel and Equipment
If the Department of Health is of the opinion that the services required by the specifications cannot
satisfactorily be performed because of insufficiency of personnel, the Department shall have the
authority to require the Contractor to use such additional personnel, to take such steps necessary
to perform the services satisfactorily at no additional cost to the State.
R.
Experience Requirements
The Contractor shall submit evidence to the satisfaction of the Department that it possesses the
necessary experience and qualifications to perform the type of services required under this contract
and must show that it is currently performing similar services. The Contractor shall submit at least
two references to substantiate these qualifications.
S.
Contract Amendments
This agreement may be amended by written agreement signed by the parties and subject to the
laws and regulations of the State pertaining to contract amendments. This agreement may not be
amended orally. The contractor shall not make any changes in the scope of work as outlined herein
at any time without prior authorization in writing from the Department of Health and without prior
approval in writing of the amount of compensation for such changes.
T.
Provisions Upon Default
1. In the event that the Contractor, through any cause, fails to perform any of the terms,
covenants or promises of this agreement, the Department acting for and on behalf of the State,
shall thereupon have the right to terminate this agreement by giving notice in writing of the fact
and date of such termination to the Contractor
2.
U.
If, in the judgement of the Department of Health, the Contractor acts in such a way which is
likely to or does impair or prejudice the interests of the State, the Department acting on behalf
of the State, shall thereupon have the right to terminate this agreement by giving notice in
writing of the fact and date of such termination to the Contractor. In such case the Contractor
shall receive equitable compensation for such services as shall, in the judgement of the State
Comptroller, have been satisfactorily performed by the Contractor up to the date of the
termination of this agreement, which such compensation shall not exceed the total cost
incurred for the work which the Contractor was engaged in at the time of such termination,
subject to audit by the State Comptroller.
Termination Provision
Upon termination of this agreement, the following shall occur:
1. Contractor shall make available to the State for examination all data, records and reports
relating to this Contract; and
2. Except as otherwise provided in the Contract, the liability of the State for payments to the
Contractor and the liability of the Contractor for services hereunder shall cease.
V.
Conflicts
If, in the opinion of the Department of Health, (1) the specifications conflict, or (2) if the
specifications are not clear as to (a) the method of performing any part of the work, or as to (b) the
types of materials or equipment necessary, or as to (c) the work required to be done in every such
situation, the Contractor shall be deemed to have based his bid upon performing the work and
furnishing materials or equipment in the most inexpensive and efficient manner. If such conflicts
and/or ambiguities arise, the Department of Health will furnish the Contractor supplementary
information showing the manner in which the work is to be performed and the type or types of
material or equipment that shall be used.
W.
MINORITY AND WOMEN OWNED BUSINESS POLICY STATEMENT
The New York State Department of Health recognizes the need to take affirmative action to ensure
that Minority and Women Owned Business Enterprises are given the opportunity to participate in
the performance of the Department of Health's contracting program. This opportunity for full
participation in our free enterprise system by traditionally, socially and economically disadvantaged
persons is essential to obtain social and economic equality and improve the functioning of the State
economy.
It is the intention of the New York State Department of Health to fully execute the mandate of
Executive Law, Article 15-A and provide Minority and Women Owned Business Enterprises with
equal opportunity to bid on contracts awarded by this agency in accordance with the State Finance
Law.
To implement this affirmative action policy statement, the contractor agrees to file with the
Department of Health within 10 days of notice of award, a staffing plan of the anticipated work force
to be utilized on this contract or, where required, information on the contractor's total work force,
including apprentices, broken down by specified ethnic background, gender, and Federal
occupational categories or other appropriate categories specified by the Department. The form of
the staffing plan shall be supplied by the Department.
After an award of this contract, the contractor agrees to submit to the Department a work force
utilization report, in a form and manner required by the Department, of the work force actually
utilized on this contract, broken down by specified ethnic background, gender and Federal
occupational categories or other appropriate categories specified by the Department.
X.
Contract Insurance Requirements
1. The successful bidder must without expense to the State procure and maintain, until final
acceptance by the Department of Health of the work covered by this proposal and the contract,
insurance of the kinds and in the amounts hereinafter provided, in insurance companies
authorized to do such business in the State of New York covering all operations under this
proposal and the contract, whether performed by it or by subcontractors. Before commencing
the work, the successful bidder shall furnish to the Department of Health a certificate or
certificates, in a form satisfactory to the Department, showing that it has complied with the
requirements of this section, which certificate or certificates shall state that the policies shall not
be changed or canceled until thirty days written notice has been given to the Department. The
kinds and amounts of required insurance are:
a. A policy covering the obligations of the successful bidder in accordance with the provisions
of Chapter 41, Laws of 1914, as amended, known as the Workers' Compensation Law, and
the contract shall be void and of no effect unless the successful bidder procures such policy
and maintains it until acceptance of the work (reference Appendix E).
b. Policies of Bodily Injury Liability and Property Damage Liability Insurance of the types
hereinafter specified, each within limits of not less than $500,000 for all damages arising
out of bodily injury, including death at any time resulting therefrom sustained by one person
in any one occurrence, and subject to that limit for that person, not less than $1,000,000 for
all damages arising out of bodily injury, including death at any time resulting therefrom
sustained by two or more persons in any one occurrence, and not less than $500,000 for
damages arising out of damage to or destruction or property during any single occurrence
and not less than $1,000,000 aggregate for damages arising out of damage to or
destruction of property during the policy period.
i.
Contractor's Liability Insurance issued to and covering the liability of the successful
bidder with respect to all work performed by it under this proposal and the contract.
ii.
Protective Liability Insurance issued to and covering the liability of the People of the
State of New York with respect to all operations under this proposal and the contract,
by the successful bidder or by its subcontractors, including omissions and supervisory
acts of the State.
iii. Automobile Liability Insurance issued to and covering the liability of the People of the
State of New York with respect to all operations under this proposal and the contract,
by the successful bidder or by its subcontractors, including omissions and supervisory
acts of the State.
Y.
Certification Regarding Debarment and Suspension
Regulations of the Department of Health and Human Services, located at Part 76 of Title 45 of the
Code of Federal Regulations (CFR), implement Executive Orders 12549 and 12689 concerning
debarment and suspension of participants in federal programs and activities. Executive Order
12549 provides that, to the extent permitted by law, Executive departments and agencies shall
participate in a government-wide system for nonprocurement debarment and suspension.
Executive Order 12689 extends the debarment and suspension policy to procurement activities of
the federal government. A person who is debarred or suspended by a federal agency is excluded
from federal financial and non-financial assistance and benefits under federal programs and
activities, both directly (primary covered transaction) and indirectly (lower tier covered transactions).
Debarment or suspension by one federal agency has government-wide effect.
Pursuant to the above-cited regulations, the New York State Department of Health (as a participant
in a primary covered transaction) may not knowingly do business with a person who is debarred,
suspended, proposed for debarment, or subject to other government-wide exclusion (including any
exclusion from Medicare and State health care program participation on or after August 25, 1995),
and the Department of Health must require its prospective contractors, as prospective lower tier
participants, to provide the certification in Appendix B to Part 76 of Title 45 CFR, as set forth below:
1. APPENDIX B TO PART 76-CERTIFICATION REGARDING DEBARMENT, SUSPENSION,
INELIGIBILITY AND VOLUNTARY EXCLUSION-LOWER TIER COVERED
TRANSACTIONS
Instructions for Certification
a. By signing and submitting this proposal, the prospective lower tier participant is
providing the certification set out below.
b. The certification in this clause is a material representation of fact upon which reliance
was placed when this transaction was entered into. If it is later determined that the
prospective lower tier participant knowingly rendered and erroneous certification, in
addition to other remedies available to the Federal Government the department or
agency with which this transaction originated may pursue available remedies, including
suspension and/or debarment.
c.
The prospective lower tier participant shall provide immediate written notice to the
person to which this proposal is submitted if at any time the prospective lower tier
participant learns that its certification was erroneous when submitted or had become
erroneous by reason of changed circumstances.
d. The terms covered transaction, debarred, suspended, ineligible, lower tier covered
transaction, participant, person, primary covered Transaction, principal, proposal, and
voluntarily excluded, as used in this clause, have the meaning set out in the Definitions
and Coverage sections of rules implementing Executive Order 12549. You may contact
the person to which this proposal is submitted for assistance in obtaining a copy of
those regulations.
e. The prospective lower tier participant agrees by submitting this proposal that, should
the proposed covered transaction be entered into, it shall not knowingly enter into any
lower tier covered transaction with a person who is proposed for debarment under 48
CFR part 9, subpart 9.4, debarred, suspended, declared ineligible, or voluntarily
excluded from participation in this covered transaction, unless authorized by the
department or agency with which this transaction originated.
f.
The prospective lower tier participant further agrees by submitting this proposal that it
will include this clause titled “Certification Regarding Debarment, Suspension,
Ineligibility and Voluntary Exclusion-Lower Tier Covered Transaction,” without
modification, in all lower tier covered transactions.
g. A participant in a covered transaction may rely upon a certification of a prospective
participant in a lower tier covered transaction that it is not proposed for debarment
under 48 CFR part 9, subpart 9.4, debarred, suspended, ineligible, or voluntarily
excluded from covered transactions, unless it knows that the certification is erroneous.
A participant may decide the method and frequency by which it determines the
eligibility of its principals. Each participant may, but is not required to, check the List of
parties Excluded from Federal Procurement and Nonprocurement Programs.
h. Nothing contained in the foregoing shall be construed to require establishment of a
system of records in order to render in good faith the certification required by this
clause. The knowledge and information of a participant is not required to exceed that
which is normally possessed by a prudent person in the ordinary course of business
dealings.
i.
Except for transactions authorized under paragraph 5 of these instructions, if a
participant in a covered transaction knowingly enters into a lower tier covered
transaction with a person who is proposed for debarment under 48 CFR part 9, subpart
9.4, suspended, debarred, ineligible, or voluntarily excluded from participation in this
transaction, in addition to other remedies available to the Federal Government, the
department or agency with which this transaction originated may pursue available
remedies, including suspension and/or debarment.
2. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion – Lower
Tier Covered Transactions
a. The prospective lower tier participant certifies, by submission of this proposal, that neither it
nor its principals is presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily exclude from participation in this transaction by any Federal
department agency.
b. Where the prospective lower tier participant is unable to certify to any of the statements in
this certification, such prospective participant shall attach an explanation to this proposal.
Z.
Confidentiality Clauses
1. Any materials, articles, papers, etc., developed by the CONTRACTOR under or in the course of
performing this AGREEMENT shall contain the following, or similar acknowledgment: "Funded
by the New York State Department of Health". Any such materials must be reviewed and
approved by the STATE for conformity with the policies and guidelines for the New York State
Department of Health prior to dissemination and/or publication. It is agreed that such review will
be conducted in an expeditious manner. Should the review result in any unresolved
disagreements regarding content, the CONTRACTOR shall be free to publish in scholarly
journals along with a disclaimer that the views within the Article or the policies reflected are not
necessarily those of the New York State Department of Health. The Department reserves the
right to disallow funding for any educational materials not approved through its review process.
2. Any publishable or otherwise reproducible material developed under or in the course of
performing this AGREEMENT, dealing with any aspect of performance under this
AGREEMENT, or of the results and accomplishments attained in such performance, shall be
the sole and exclusive property of the STATE, and shall not be published or otherwise
disseminated by the CONTRACTOR to any other party unless prior written approval is secured
from the STATE or under circumstances as indicated in paragraph 1 above. Any and all net
proceeds obtained by the CONTRACTOR resulting from any such publication shall belong to
and be paid over to the STATE. The STATE shall have a perpetual royalty-free, non-exclusive
and irrevocable right to reproduce, publish or otherwise use, and to authorize others to use, any
such material for governmental purposes.
3. No report, document or other data produced in whole or in part with the funds provided under
this AGREEMENT may be copyrighted by the CONTRACTOR or any of its employees, nor
shall any notice of copyright be registered by the CONTRACTOR or any of its employees in
connection with any report, document or other data developed pursuant to this AGREEMENT.
4. All reports, data sheets, documents, etc. generated under this contract shall be the sole and
exclusive property of the Department of Health. Upon completion or termination of this
AGREEMENT the CONTRACTOR shall deliver to the Department of Health upon its demand
all copies of materials relating to or pertaining to this AGREEMENT. The CONTRACTOR shall
have no right to disclose or use any of such material and documentation for any purpose
whatsoever, without the prior written approval of the Department of Health or its authorized
agents.
5. The CONTRACTOR, its officers, agents and employees and subcontractors shall treat all
information, which is obtained by it through its performance under this AGREEMENT, as
confidential information to the extent required by the laws and regulations of the United States
and laws and regulations of the State of New York.
6. All subcontracts shall contain provisions specifying:
a. that the work performed by the subcontractor must be in accordance with the terms of this
AGREEMENT, and
b. that the subcontractor specifically agrees to be bound by the confidentiality provisions set
forth in the AGREEMENT between the STATE and the CONTRACTOR.
AA.
Provision Related to Consultant Disclosure Legislation
1. If this contract is for the provision of consulting services as defined in Subdivision 17 of Section
8 of the State Finance Law, the CONTRACTOR shall submit a "State Consultant Services
th
Form B, Contractor's Annual Employment Report" no later than May 15 following the end of
each state fiscal year included in this contract term. This report must be submitted to:
a. The NYS Department of Health, at the STATE's designated payment office address
included in this AGREEMENT; and
b. The NYS Office of the State Comptroller, Bureau of Contracts, 110 State Street, 11th Floor,
Albany NY 12236 ATTN: Consultant Reporting - or via fax at (518) 474-8030 or (518) 4738808; and
c.
BB.
The NYS Department of Civil Service, Alfred E. Smith Office Building, Albany NY 12239,
ATTN: Consultant Reporting.
Provisions Related to New York State Procurement Lobbying Law
1. The STATE reserves the right to terminate this AGREEMENT in the event it is found that the
certification filed by the CONTRACTOR in accordance with New York State Finance Law §139k was intentionally false or intentionally incomplete. Upon such finding, the STATE may
exercise its termination right by providing written notification to the CONTRACTOR in
accordance with the written notification terms of this AGREEMENT.
CC. Provisions Related to New York State Information Security Breach and Notification Act
1. CONTRACTOR shall comply with the provisions of the New York State Information Security Breach
and Notification Act (General Business Law Section 899-aa; State Technology Law Section 208).
CONTRACTOR shall be liable for the costs associated with such breach if caused by
CONTRACTOR’S negligent or willful acts or omissions, or the negligent or willful acts or omissions
of CONTRACTOR’S agents, officers, employees or subcontractors.
ATTACHEMENT 14
New York State Department of Health
M/WBE Procurement Forms
The following forms are required to maintain maximum participation in M/WBE
procurement and contracting:
1.
Bidders Proposed M/WBE Utilization Form
2.
Minority Owned Business Enterprise Information
3.
Women Owned Business Enterprise Information
4.
M/WBE Utilization Plan
5
M/WBE Letter of Intent to Participate
6.
M/WBE Staffing Plan
New York State Department of Health
BIDDERS PROPOSED M/WBE UTILIZATION PLAN
Bidder Name:
RFP Number
RFP Title:
Description of Plan to Meet M/WBE Goals
PROJECTED M/WBE USAGE
%
Amount
100
$
1.
Total Dollar Value of Proposal Bid
2.
MBE Goal Applied to the Contract
$
3.
WBE Goal Applied to the Contract
$
4.
M/WBE Combined Totals
$
New York State Department of Health
MINORITY OWNED BUSINESS ENTERPRISE (MBE)
INFORMATION
In order to achieve the MBE Goals, bidder expects to subcontract with New York State certified MINORITY-OWNED
entities as follows:
MBE Firm
(Exactly as Registered)
Name
Projected MBE
Dollar Amount
Description of Work (Products/Services) [MBE]
$
Address
City, State, ZIP
Employer I.D.
Telephone Number
(
)
Name
$
Address
City, State, ZIP
Employer I.D.
Telephone Number
(
)
Name
$
Address
City, State, ZIP
Employer I.D.
Telephone Number
(
)
-
New York State Department of Health
WOMEN OWNED BUSINESS ENTERPRISE (WBE) INFORMATION
In order to achieve the WBE Goals, bidder expects to subcontract with New York State certified WOMEN-OWNED
entities as follows:
WBE Firm
(Exactly as Registered)
Projected WBE
Dollar Amount
Description of Work (Products/Services) [WBE]
Name
$
Address
City, State, ZIP
Employer I.D.
Telephone Number
(
)
Name
$
Address
City, State, ZIP
Employer I.D.
Telephone Number
(
)
Name
$
Address
City, State, ZIP
Employer I.D.
Telephone Number
(
)
-
New York State Department of Health
M/WBE UTILIZATION PLAN
Agency Contract:______________________________________ Telephone:______________________
Contract Number:______________________________________ Dollar Value:____________________
Date Bid:________________ Date Let:__________________ Completion Date:___________________
Contract Awardee/Recipient:___________________________________
Name
_____________________________________________________________
Address
_____________________________________________________________
Telephone
Description of Contract/Project Location:___________________________________________________
Subcontractors Purchase with Majority Vendors:
Participation Goals Anticipated:________________ % MBE __________________% WBE
Participation Goals Achieved: ________________ % MBE __________________% WBE
Subcontractors/Suppliers:
Firm Name
and City
Description of
Work
Dollar
Value
Date of
Subcontract
Identify if
MBE or WBE or
NYS Certified
Contractor’s Agreement: My firm proposes to use the MBEs listed on this form
Prepared By:
(Signature of Contractor)
Print Contractor’s Name:
Telephone #:
Grant Recipient Affirmative Action Officer Signature (If applicable):
Reviewed: By:
FOR OFFICE USE ONLY
Date:
M/WBE Firms Certified:_______________
CBO:_______________
Not Certified:_____________________
MCBO:_____________________
Date:
New York State Department of Health
MWBE ONLY
MWBE SUBCONTRACTORS AND SUPPLIERS
LETTER OF INTENT TO PARTICIPATE
To: ________________________________ Federal ID Number: ___________________
(Name of Contractor)
Proposal/ Contract Number: _______________________
Contract Scope of Work: ______________________________________________________
The undersigned intends to perform services or provide material, supplies or equipment as:_________________________________
______________________________________________________________________________
Name of MWBE: ______________________________________________________________
Address: _____________________________________________________________________
Federal ID Number: ____________________________________________________________
Telephone Number: ____________________________________________________________
Designation:
MBE - Subcontractor
Joint venture with:
WBE - Subcontractor
Name: ____________________________
Address: _________________________
MBE - Supplier
________________________________
WBE - Supplier
Fed ID Number: ___________________
MBE
WBE
Are you New York State Certified MWBE? _____________Yes _____________No
The undersigned is prepared to perform the following work or services or supply the following materials, supplies or
equipment in connection with the above proposal/contract. (Specify in detail the particular items of work or services to be
performed or the materials to be supplied): ___________________
______________________________________________________________________________
at the following price: $ _____________________________
The contractor proposes, and the undersigned agrees to, the following beginning and completion dates for such work.
Date Proposal/ Contract to be started: _______________________________________
Date Proposal/ Contract to be Completed: _____________________________________
Date Supplies ordered: __________________________ Delivery Date: __________
The above work will not further subcontracted without the express written permission of the contractor and notification of the
Office. The undersigned will enter into a formal agreement for the above work with the contractor ONLY upon the
Contractor’s execution of a contract with the Office.
____________________
Date
______________________________________
Signature of M/WBE Contractor
______________________________________
Printed/Typed Name of M/WBE
Contractor
INSTRUCTIONS FOR M/WBE SUBCONTRACTORS AND SUPPLIERS LETTER OF INTENT
TO PARTICIPATE
This form is to be submitted with bid attached to the Subcontractor’s Information Form in a sealed envelope for each
certified Minority or Women-Owned Business enterprise the Bidder/Awardee/Contractor proposes to utilize as
subcontractors, service providers or suppliers.
If the MBE or WBE proposed for portion of this proposal/contract is part of a joint or other temporarily-formed
business entity of independent business entities, the name and address of the joint venture or temporarily-formed business
should be indicated.
Page 2
New York State Department of Health
M/WBE STAFFING PLAN
Check applicable categories:
Project Staff
Consultants
Subcontractors
Contractor Name_________________________________________________________________________
Address
_________________________________________________________________
_________________________________________________________________
Total
Male
Female
STAFF
Administrators
Managers/Supervisors
Professionals
Technicians
Clerical
Craft/Maintenance
Operatives
Laborers
Public Assistance Recipients
TOTAL
____________________________________________
(Name and Title)
____________________________________________
Date
Black
Hispanic
Asian/
Pacific
Islander
Other